Burden of disability in type 2 diabetes mellitus and the moderating effects of physical activity.

The growing diabetic epidemic has created a substantial burden, not only on the people with diabetes but also on society at large. This mini-review discussed the limitations and patterns of disability in type 2 diabetes mellitus and put forward a case for the moderating effects of physical activity (PA) in the management of diabetes. The limitations and impairments associated with diabetes include vascular, neurological, cardiac, and renal impairments. Moreover, individuals participate less in their daily lives and in their instrumental activities of daily living, which negatively impacts the quality of life of individuals with diabetes. This often leads to a loss of quality of life due to disabilities, resulting in an increased rate of disability-adjusted life years among people with type 2 diabetes mellitus. Moreover, there are psychosocial sequelae of diabetes mellitus. This necessitates looking for moderating factors that may reduce the burden of the disease. PA has been shown to be one of the factors that can mitigate these burdens. PA does this in several ways, including through the benefits it confers, such as a reduction of hemoglobin A1c, a reduction of excess fat in the liver and pancreas, and the reduction of cardiovascular risk factors, all of which favorably affect glycemic parameters. Specifically, PA regulates or moderates diabetes disability through two mechanisms: The regulation of glucolipid metabolism disorders and the optimization of body mass index and systemic conditions. Therefore, efforts should be directed at PA uptake through identified strategies. This will not only prevent diabetes or diabetes complications but will reduce its burden.

Spectrum of Endocrine Disorders as Seen in a Tertiary Health Facility in Sagamu, Southwest Nigeria.

BACKGROUND: There is dearth of records on prevalence and spectrum of adult endocrine disorders in Nigeria. OBJECTIVE: To document the spectrum of endocrine disorders as seen in endocrinology, diabetes, and metabolism (EDM) outpatient clinic, Department of Medicine of Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State over a 3-year period. METHODS: This was a retrospective study of the medical records of all new consultations seen in the EDM outpatient clinic between January 2016 and December 2018. All endocrinology diagnoses were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health problems (ICD-10). Information on demographic, source of referral, baseline clinical, and biochemical indices were gleaned and subjected to descriptive statistics using SPSS version 21, and results were presented as proportions (frequencies and percentages) and mean (±standard deviation). RESULTS: Two thousand seven hundred and sixty-five patients were seen and managed at EDM outpatient clinic over the specified time frame. Eight hundred and sixty-three were new cases, age range 16-88, mean of 54.10 (±13.9) years with female preponderance 520 (60.3%) and female-to-male ratio of 1.5:1. The internal referral system constituted the main means of referral to the EDM clinic. The most common endocrine referrals were diabetes mellitus (DM) (697, 80.8%) and thyroid disorders (119, 13.8%) followed by metabolic syndrome (29, 3.36%) and hypothalamic-pituitary disorders (HPOs, 9, 1.04%). CONCLUSION: The common endocrine cases seen in Sagamu are DM, thyroid diseases, metabolic syndrome, and HPO similar to worldwide trend.

Global disability burden and its predictors among adult Nigerians living with Type-2 diabetes.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a public health issue associated with a high prevalence of disability. Studies on disability profile in terms of reduction in body structure and function, personal activities and societal participation, defined as 'global disability', are scarce among people living with T2DM in Nigeria. OBJECTIVES: To assess the prevalence of global disability and its predictors among Nigerian living with T2DM. METHODS: A cross-sectional analysis of 162 patients diagnosed with T2DM and attending a tertiary health facility was performed for global disability measure and function. Their clinical and socio-demographic data were obtained. Poisson regression analysis was applied to assess the predicting factors of disability. RESULTS: A mean global disability score of 22.1 was reported among the participants, varying from moderate to high in each item. About 25.0% had mild disability, while 60.5% reported moderate to severe disability. Elevated glycosylated haemoglobin, fasting blood glucose, systolic blood pressure, age, disease duration and marital status predicted disability. A unit increase in HbA1c, systolic blood pressure and 1 month increase in DM duration had more disability reported estimates [1.062 (CI=1.050-1.075), 1.005 (CI=1.002-1.007) and 1.001 (CI=1.000-1.002) times, respectively]. Married participants were 1.13 (CI=1.02-1.23) times more likely to be disabled than unmarried. CONCLUSIONS: There is mild to moderate burden and risk of global disability among Nigerian living with T2DM. Age, DM duration, marital status, fasting blood glucose, glycosylated haemoglobin and systolic hypertension significantly predicted disability. FUNDING: None declared.

Global disability burden and its predictors among adult Nigerians living with type-2 diabetes

Background: Type 2 diabetes mellitus (T2DM) is a public health issue associated with a high prevalence of disability.Studies on disability profile in terms of reduction in body structure and function, personal activities and societal participation, defined as 'global disability', are scarce among people living with T2DM in Nigeria. Objectives: To assess the prevalence of global disability and its predictors among Nigerian living with T2DM. Methods: A cross-sectional analysis of 162 patients diagnosed with T2DM and attending a tertiary health facility was performed for global disability measure and function. Their clinical and socio-demographic data were obtained. Poisson regression analysis was applied to assess the predicting factors of disability. Results: A mean global disability score of 22.1 was reported among the participants, varying from moderate to high in each item. About 25.0% had mild disability, while 60.5% reported moderate to severe disability. Elevated glycosylated haemoglobin, fasting blood glucose, systolic blood pressure, age, disease duration and marital status predicted disability. A unit increase in HbA1c, systolic blood pressure and 1 month increase in DM duration had more disability reported estimates [1.062 (CI=1.050-1.075), 1.005 (CI=1.002-1.007) and 1.001 (CI=1.000-1.002) times, respectively]. Married participants were 1.13 (CI=1.02-1.23) times more likely to be disabled than unmarried. Conclusions: There is mild to moderate burden and risk of global disability among Nigerian living with T2DM. Age, DM duration, marital status, fasting blood glucose, glycosylated haemoglobin and systolic hypertension significantly predicted disability

Prevalence, Predictive Factors, and Characteristics of Osteoporosis in Hyperthyroid Patients.

OBJECTIVE: The osteoporosis in thyroid disorder has the lowest report especially in sub-Saharan Africa. This study aims to determine the prevalence, predictive factors, and characteristics of osteoporosis in hyperthyroid patients. METHOD: Forty (40) hyperthyroid patients and healthy controls ages 21-50 years were recruited in this study. Questionnaires were administered to capture bio- and clinical data. Biochemical tests included blood, thyroid functions, intact parathyroid hormone, corrected calcium, and 25-hydroxyvitamin D tests. Bone mineral density (BMD) was also evaluated. Data were analyzed using the SPSS 21. A p value < 0.05 was regarded as significant. RESULTS: Osteoporosis was observed in 18 (45%) of study subjects, 13 (72.2%) females and 5 (27.8%) males, respectively. The BMD of the hyperthyroid patients had a negative correlation with free triiodothyronine, FT3 (r = -0.49, p = 0.005), FT4 (r = -0.33, p = 0.009), corrected calcium (r = -0.31, p = 0.039), alkaline phosphatase (r = -0.53, p < 0.001), and osteocalcin (r = -0.61, p < 0.001). Conversely, a positive association with thyroid-stimulating hormone (TSH) (r = 0.54, p < 0.001) was observed. Multiple regression showed osteocalcin (p < 0.001) and TSH (p = 0.015) as independent predictors of osteoporosis. CONCLUSION: Thyrotoxicosis is a risk factor for osteoporosis occurrence, and we recommend routine screening for this bone disease in persons over 20 years old with this disorder.

Latent Autoimmune Diabetes Mellitus in Adults (LADA) and it's characteristics in a subset of Nigerians initially managed for type 2 diabetes.

INTRODUCTION: Latent autoimmune diabetes in adults (LADA) is an entity characterized by the presence of GAD autoantibodies. LADA is largely understudied and underreported amongst Nigerians with Diabetes Mellitus (DM). We undertook to document the Prevalence, clinical and biochemical characteristics of LADA in a subset of Nigerians who hitherto had been treated for type 2 DM. METHODS: This is a cross-sectional study conducted on 235 patients being managed for type 2 DM. The diagnosis of LADA was made in the presence of Glutamic Acid Decarboxylase autoantibody (GADA) positivity in the study subjects. Thereafter persons with LADA were compared with those without LADA. Clinical parameters such as demographic data, history of diabetes mellitus (DM) and its complications were obtained, biochemical parameters including Fasting blood glucose (FBG), C-peptide, glycated haemoglobin (HbA1c) and lipid parameters were compared in both groups of Study subject. Test statistics used were Student t- test and χ 2. SPSS was used for data analysis. RESULTS: Thirty three out of 235 of the Study subjects were GADA positive, giving a prevalence of 14%. The mean age (SD) of the subjects with LADA is 53.24(7.22) with an age range of 30-63 years. Majority (48%) of LADA subjects were in the 50-59 age category. There was no significant difference in the proportion of males and females with LADA (p = 0.3). 37% of patients with LADA were on insulin for glycaemic control. Three (3) LADA subjects had history/clinical evidence of autoimmune thyroid disease. 66% of LADA were in the overweight/obese category. LADA subjects had significant poor long term glycaemic control compared with anti-GAD negative subjects (p = 0.026). About half of LADA subjects were insulinopaenic. LADA subjects had lower levels of total cholesterol than GADA-ve subjects (p = 0.03). A higher proportion of LADA had evidence of microvascular complications of DM compared with antiGAD negative individuals. CONCLUSION: The diagnosis of LADA should be entertained in overweight/obese persons from the fourth decade of life presenting with DM. Pharmacotherapy with insulin is a potential means of managing hyperglycaemia in this group of patients especially since a significant proportion are insulinopaenic. The Prevalence of LADA in our patients is comparable to what obtains in Ghanaian and Caucasian populations.