Prevalence and pattern of dyslipidaemia in type 2 diabetes mellitus patients at a tertiary care hospital

Background: Diabetes mellitus (DM) is a common secondary cause of dyslipidaemia, particularly if glycaemic control is poor, which in turn is an important risk factor for atherosclerosis and coronary artery disease.Objectives: (1) To study the prevalence and pattern of dyslipidaemia in patients with type 2 DM. (2) To determine the relationship (if any) between HbA1C and the lipid profile in type 2 diabetic patients.Methods: This was a cross-sectional study done in 200 type 2 diabetic patients attending the Diabetic Clinic at the Helen Joseph Hospital. Patients suffering from other known causes of secondary dyslipidaemia were excluded. Each patient's HbA1C and lipid profile results were recorded from their clinic files. The lipid profile included total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and calculated low-density lipoprotein cholesterol (LDL-C). Patients with one or more of the above parameters outside the targets recommended by the 2012 South African Dyslipidaemia Guidelines were considered to have uncontrolled dyslipidaemia.Results: Of the 200 type 2 DM patients studied, 86 (43%) were male and 114 (57%) female. Despite all patients being treated with lipid-lowering therapy (simvastatin at a mean daily dose of 20 mg), 187 patients (93.5%) did not achieve all their lipid targets. The most prevalent lipid parameter not at target was an LDL-C of ≥ 1.8 mmol/l in nearly 80% of patients. The most common pattern of dyslipidaemia was a combined dyslipidaemia(any two abnormal lipid parameters) affecting a total of 82 out of the 187 patients (43.8%) not reaching recommended targets. No significant relationship was found between HbA1C and any of the lipid parameters. Conclusion: The vast majority of the type 2 diabetic patients studied had dyslipidaemia not meeting recommended targets, despite the use of lipid-lowering therapy in all patients. There is a need for more intensive lipid-lowering therapy, particularly statin therapy in patients with dyslipidaemia. Measures aimed at combating obesity and other lifestyle-related risk factors are also vital and need to be implemented for effectively controlling dyslipidaemia and reducing the burden of CVD

Comparison of glycaemic indices of some local beans (Vigna unguiculata [Linn] Walp varieties) in Nigerians

Background: Beans are recommended for their richness and for their salutary effect on blood glucose. Inter-species differences impact on blood glucose. What appeared unknown is whether varieties of beans of the same species (Vigna unguiculata [Linn] Walp) have differential effects on blood glucose when equal amounts are consumed.Objective: To perform proximate analysis and compare the glycaemic indices on consumption of Vigna unguiculata (Linn) Walp species. Setting and subjects: This was an experimental study and subjects consisted of 12 healthy consenting participants at Lagos University Teaching Hospital (LUTH) in Lagos, Nigeria.Outcome measure: Fibre contents and the glycaemic indices of Vigna unguiculata (Linn) Walp varieties 'oloyin', 'drum' and 'Sokoto' white.Results: The mean (±SD) crude fibre content of Vigna unguiculata (Linn) Walp varieties 'oloyin', 'drum' and 'Sokoto white' are 2.75% (± 0.00), 2.64% (± 0.14) and 2.94% (± 0.17) respectively. The median (95% CI) glycaemic index (GI) of Vigna unguiculata (Linn) Walp variety 'oloyin' was 12.10% (6.0­16.31), variety 'drum' 17.64% (9.22­48.93) and variety 'Sokoto white' 12.04% (5.54­28.94) respectively. The GI of the bean meals differed significantly (Friedman's test, χ2 (2) = 6.500, p = 0.039).Conclusion: The fibre content of intra-species beans, together with their GI, differs. 'Drum' bean meal has the lowest fibre content and highest glycaemic response. 'Oloyin' and 'Sokoto white' bean meals are recommended for persons with DM as some beans are more diabetic friendly than others

Diabetic patients' perspectives on the challenges of glycaemic control

Introduction: The factors affecting the control of diabetes are complex and varied. However; little is documented in the literature on the overall knowledge of diabetic patients about glycaemic control. This study explored the patients' perspectives on the challenges of glycaemic control. Methods: In this qualitative study, semi-structured interviews were conducted with seventeen purposively selected diabetic patients with HBA1c = 9% at Mthatha General Hospital, South Africa. The interviews were conducted in the isiXhosa language and were audiotaped. Two experienced qualitative researchers independently transcribed and translated the interviews.Thematic content analysis was conducted. Results: Three main themes emerged: overall knowledge of diabetes and treatment targets, factors affecting the control of diabetes and how glycaemic control could be improved. The majority of the participants demonstrated poor knowledge of treatment targets for diabetes. The majority of the participants reported that lack of money affected their control of diabetes. Some of the participants reported that the nearest clinics do not have doctors; hence,they are compelled to travel long distances to see doctors. Conclusion: Poverty; lack of knowledge and access to doctors affect the control of diabetes in the rural communities of Mthatha; South Africa. The government should address recruitment and retention of doctors in primary health care

Oxidative Stress and Glycaemic Control in Type 2 Diabetic Patients in Enugu; South-East Nigeria

Background: There is growing evidence that excess generation of highly reactive free radicals; largely due to hyperglycaemia causes oxidative stress; which further exacerbates the development and progression of type 2 diabetes and its complications. Objectives: In this study; the level of oxidative stress was compared with glycaemic control in type 2 diabetic patients. Method: Fifty confirmed type 2 diabetic patients; aged between 25 and 70 years were used for the study. 20 patients with good glycaemic control served as positive control while 20 apparently healthy non-diabetic age-matched individuals served as negative control. The FBS; MDA and HbA1c were determined in fasting blood samples using standard methods. Results: Patients with poor glycaemic control had significantly raised MDA and HbA1c (P =0.0001) when compared with non diabetics However; those with good glycaemic control only had a significant increase in the MDA when compared to non diabetic. (P =0.0001).).The MDA level when compared to fasting blood sugar (FBS) and glycated haemoglobin (HbA1c) showed a positive correlation.( r= 0.77; P = 0.0001 and r=0.69; P = 0.0001 respectively) Conclusion: This study showed that both glycaemic control and lipid peroxidation are factors to be monitored or evaluated in the management of type2 diabetics to avoid the development of diabetic complications

Trace mineral status and glycaemic control in Nigerians with type 2 diabetes

Diabetes has been shown to be associated with abnormalities in the metabolism of micronutrients, especially chromium, zinc, copper, magnesium, and manganese. People with type 2 diabetes attending the Diabetes Clinic of the University of Benin Teaching Hospital, were recruited to examine the relationship between trace mineral status and glycaemic control. A total of 120 persons were studied, mean (±SD) age was 54±7 years and mean duration of diabetes 4±4 years. Serum chromium level correlated inversely with fasting blood glucose (FBG) and HbA1c, unlike the serum concentration of zinc which had no significant correlation with either FBG or HbA1c. People with diabetes should be encouraged to eat local specific foods rich in chromium

Factors Contributing to Poor Glycaemic Control in Diabetic Patients at Mopani District

Diabetes mellitus is not only a major burden in the developed world; it is also an increasing health problem in less developed countries. Although health education could be a tool to achieve better glycaemic control; it is important to understand that health education should be adjusted to patients' literacy; cultural environment and economic status. Among other factors; lack of money has an influence on the outcome of diabetes mellitus. Thus the purpose of the study is to identify factors contributing to poor glycaemia control in diabetic patients. Data was collected using self-report questionnaire on a convenient sample of 32 diabetic patients and unstructured; open-ended interviews on eight patients' inorder to allow them freedom of expressing themselves with regard to factors that contribute to poor glycaemic control on diabetic patients. Data was then analysed using a computer program called Statistical Package for Social Sciences. The socioeconomic factors appeared to have significant influence on glycaemic control among participants; for instance 75of the total subjects (32) indicated that they experienced problems of accessing health care services due to lack of money. Ignorance related to where to seek support system such as educational programme; and nutrition counselling were factors that were identified to contribute to diabetic patients' poor glycaemia control. Permission to conduct the study was obtained from the Provincial Department of Health and the managers of the institutions where the study was conducted. Recommendations for dealing with the identified factors have been formulated

Diabetic complications and glycaemic control in remote North Africa

Background: Delivery of diabetes services in resource-poor areas of Africa is difficult. Control is often poor and complications are common. However, adequate robust surveys are uncommon, particularly in remote rural areas. This makes needs assessment difficult and health-care planning impossible. Aim: To accurately assess the glycaemic control and burden of complications in a group of diabetic patients from a remote area of a resource-limited north African country. Design: Prospective cohort study. Methods: Over a 6-week period, all patients attending the diabetic clinic at Mekelle Hospital in northern Ethiopia were intensively assessed, using imported western technology as necessary. Glycated haemoglobin (HbA1c), lipid profile, serum creatinine and urinary albumin­creatinine ratio were measured. Complications were assessed as accurately as possible, including examination of fundi by an ophthalmic specialist, and biosthesiometry for neuropathy. Results: There were 105 patients, mean (± SD) age 41 ± 16 years and diabetes duration 7 ± 6 years. There were 74 (70%) males, and 69 (66%) on insulin. Median body mass index was low at 20.6 kg/m2, but mean HbA1c high at 11.3 ± 2.8% (68% had an HbA1c over 10.0%). Cataract (12%), retinopathy (21%), neuropathy (41%) and microalbuminuria (51%) were common; but nephropathy (2%) was rare, as was large vessel disease (6% had peripheral vascular disease, and none had coronary artery disease or cerebrovascular disease). Risk factors such as hypertension (5%) and smoking (2%) were uncommon, and lipid profiles were generally good. Discussion: We conclude that in this severely resource-limited area of North Africa, glycaemic control amongst diabetic patients is very poor. Neuropathy, retinopathy and microalbuminuria are common; but large vessel disease risk factors are beneficial, and macroangiopathy prevalence is low. Scattered populations, shortage of drugs and insulin and lack of diabetes team care are major factors behind these serious issues of diabetic control and complications

Glycaemic Response to Different Preparations of Yam in Diabetic and Non-Diabetic Nigerians

Post-pandial glycaemic responses to food can be affected by the method involved in the preparation of the food. Dietary intervention with food modification forms the corner- stone of management of type 2 diabetes worldwide. The effect of processing on yam; a staple food in Nigeria; was studied among diabetic and non-diabetic Nigerians. Despite undergoing more processing; amala prepared from yam flour had a better post-pandial glycaemic response index (PGRI) compared to other yam preparations; and this was also significantly higher among the diabetic subjects. Yam-based products; particularly amala; should be encouraged among diabetic Nigerians