Selfmonitoring of blood glucose practices by people living with diabetes who use their personal glucometers in Port Harcourt, Niger Delta Region, Nigeria

Self-monitoring of blood glucose (SMBG) assists persons living with diabetes with the day-to-day behavioral and therapeutic adjustments to their diabetes care. It is a cheaper and more available alternative to glycated haemoglobin (HbA1c) in Nigeria for monitoring glycaemic control. Information on SMBG practices of Nigerians living with diabetes using their personal glucometers is scanty. The aim of the study is to assess the intensity and frequency of SMBG by glucometer owners, and the extent the patients and/or the health care providers (HCP) utilize SMBG to achieve personalized treatment goals via behavioral/treatment adjustments. This was a cross sectional study carried out among persons living with diabetes that accessed diabetes care at the diabetes clinic of the University of Port Harcourt Teaching Hospital (UPTH) and using their personal glucometers. They were consecutively recruited. Data obtained by using interviewer-administered questionnaires were analyzed using SPSS version 20.0, and pvalue <0.05 was considered significant. A total of 128 persons living with diabetes participated in the study of which 40 (31%) were males and 88 (69%) were females; the mean age of the subjects was 52.05 ± 11.24 years with a range of 26­70 years. The majority of the study subjects (72%) were in the active working age group (25­60years). The highest frequency of glucometer use was in the 26 subjects (20%) who checked their blood glucose every morning while 62 (48%) of the subjects checked their blood glucose any morning they felt like. Most of the subjects (60%) did not have any recording device. Glucometer owners were not just the insulin-requiring people living with diabetes as more than half of the subjects, 66 (52%) were on oral anti diabetic drugs (OAD) only. Glucometer ownership was mainly by those that were in the working age group. SMBG protocol (frequency) was variable and SMBG data were not maximally utilized

Self blood glucose monitoring among diabetic patients in Port Harcourt, Nigeria

Self blood glucose monitoring (SBGM) is important in the management of people living with diabetes. This study set out to evaluate the knowledge and practice of SBGM in diabetic patients at our clinic in Port Harcourt, Nigeria. Ninety (90) diabetic patients attending the clinic were assessed with self-administered questionnaires. There were 36 (40%) males and 54 (60%) females with a mean age of 54±23 years, and a mean duration of diabetes of 8 years. Eighty-one (90%) had type 2 diabetes while nine (10%) had type 1 diabetes. Eighteen type 2 patients (20%) were on insulin alone, 52 (58%) on oral drugs, and 20 (22%) were on a combination. Fifty-two patients knew only about using glucose meters for SBGM, 30 knew about using both meters and urine dipsticks, and 4 did not know of any method. Only 24 (27%) patients had glucose meters and no type 1 patient had a meter. The highest frequency of monitoring was once daily in six patients. None of the patients practised urine monitoring. In conclusion, this study has shown that the practice of SBGM in our patients is inadequate despite reasonable knowledge of the technique. This is most likely due to scarce resources. The importance of SBGM should be emphasised more in our practice, especially in patients with type 1 diabetes, and there should be motivation for improved self-monitoring resources

Thyrotoxicosis - a Review

"Background: Thyrotoxicosis is the clinical and biochemical manifestations of exposure of tissues to excessive quantities of thyroid hormones; specifically free thyroxine (T4 ); tri-iodothyronine (T3) or both. The terms ""thyrotoxicosis""; ""hyperthyroidism"" and ""Graves' disease"" are used interchangeably because hyperthyroidism due to Graves' disease is the commonest cause of thyrotoxicosis. Studies in most countries reveal an increasing incidence of thyrotoxicosis. Aim: To present an update on the causes and management of thyrotoxicosis with emphasis on Graves' disease. Methods: A review of publications obtained from medline search and Google on ""thyrotoxicosis"" or ""Graves' disease"" or ""hyperthyroidism"" was done. Results: Graves' disease constitutes about 70of cases of thyrotoxicosis.The common clinical features include weight loss despite enhanced appetite; hyperactivity and heat intolerance etc. Features specific to Graves' disease include ophthalmopathy; pretibial myxoedema and thyroid acropachy. Thyrotoxicosis affects about 1of women and 0.1of men globally. It is indicated in most cases by an elevated serum concentration of total T4 and T3 and a suppressed thyroid stimulating hormone (TSH). Thyroid imaging and radiotracer uptake measurements combined with serological data enable specific aetiological diagnosis. The three treatment modalites for Graves' disease are antithyroid drugs; 131I therapy and thyroidectomy. Conclusion: The incidence of thyrotoxicosis is increasing globally. Optimal clinical and laboratory evaluation of the patient is necessary to identify the cause and institute appropriate therapy. There is need for prospective studies to identify the factors for the observed increasing incidence of thyrotoxicosis in our population"

Double diabetes: an emerging disease in children and young adults

Background: Studies in most countries have shown an increasing incidence of diabetes mellitus in children and young adults. Double diabetes is a newly recognized problem in children with different diagnostic and therapeutic measures. Methods: A review of over 30 literature obtained from Google; PUBMED search and journal publications on ""double diabetes"" was done to determine the incidence; pathophysiology; pathogenesis; diagnostic criteria; treatment and prevention of double diabetes in children and young adults. Results: Most of the reports on double diabetes were from western countries and Asia. Type 1 diabetes resulting from antibodies to the insulin-producing pancreatic beta cell was more prevalent in children. However; with increasing obesity the incidence of type 2 diabetes resulting from insulin resistance was high in children and young adults. Most patients with double diabetes were established type 1 diabetics; who while on insulin and on hypercaloric diet developed obesity especially during puberty and hence associated type 2 diabetes. The incidence was more in black than in white children. They presented with some clinical and laboratory features of both types 1 and 2 diabetes. Some authors advocated treatment with both insulin and oral hypoglycaemic drugs mainly metformin to improve insulin sensitivity. Prevention of childhood obesity by encouraging physical activities and dietary control would prevent double diabetes. Conclusion: Double diabetes is increasing in children and young adults. A high index of suspicion is required in obese children with diabetes

The Pattern and distribution of communicable diseases among medical admissions in Port Harcourt, Nigeria

Background: Global and regional estimates show that non-communicable diseases are rising in importance relative to other causes of ill health as populations age and the fight continues against communicable diseases. However; communicable diseases remain a major cause of mortality and morbidity in the developing world.Aim: The study was carried out to determine the pattern of communicable diseases in the medical wards of the University of Port Harcourt Teaching Hospital; (UPTH) over four consecutive years (June2000 June 2004). Methods: The study was retrospective and data were obtained from the medical registers in the medical wards and the records department of the University of Port Harcourt Teaching Hospital. Medical admissions due to communicable diseases were carefully selected and analyzed.Results: There were 1441 cases of various communicable diseases out of a total of 3294 medical admissions constituting 43.8; while non-communicable diseases accounted for 56.2.The top ten communicable diseases identified were tuberculosis; HIV/AIDS; septicaemia; lobar pneumonia; acute viral hepatitis; chronic liver disease(viral); enteric fever; malaria; urinary tract infections and amoebic liver disease. Conclusion: Communicable diseases still remain a major cause of morbidity in Port Harcourt hence the double burden of disease. There is need for improvement in housing; provision of portable water; immunization; health education and improved sanitation amongst other social amenities to reduce the scourge of communicable diseases in Nigeria