Age at diagnosis and duration of type 2 diabetes seen in Benin City, Nigeria

It has been reported that type 2 diabetes is occurring at an earlier age than previously. We have therefore studied the age at diagnosis and duration of type 2 diabetes among Nigerians. There were 732 patients studied, of whom 467 (64%) were female. Mean age was 58±11 years, and mean diabetes duration was 5±5 years. The commonest age at diagnosis was in the fifth decade and 69% of the patients had been diagnosed within the last 5 years. This may be due to increased rates of diagnosis of diabetes, or high mortality in those with a longer duration of diabetes

Hyperglycemic crisis precipitated by Lassa fever in a patient with previously undiagnosed type 2 diabetes mellitus.

Hyperglycemic crisis (HC) is an acute complication of diabetes mellitus (DM) that is commonly precipitated by infections and non-compliance with therapy. Viral precipitant of HC is uncommon. To report a rare case of HC unmasked by Lassa fever in a patient previously not known to have diabetes mellitus. A 54 year old lady presented with complaints of generalized body weakness, inability to pass stool, and fever. There was no abdominal pain, vomiting and nausea. There were no features of DM. She is not a known case of diabetes mellitus or hypertension. Patient does not drink alcoholic beverages. There was no history of bleeding from any orifices. She was acutely ill-looking, afebrile, not pale, anicteric, nil pedal oedema. Pulse rate was 110 beats per minute, regular, normal volume. Blood pressure was 110/80 mmHg. Respiratory rate was 26 cycles/minute, breath sound was vesicular. Abdomen was full and moved with respiration. There were no areas of tenderness, no organomegaly, no ascites, and bowel sounds were normoactive. Neurologic examination revealed a conscious patient who was restless. Casual blood glucose was 600mg/dl. Urinalysis: Glycosuria (+++), HbA1c was 12.4%. Lassa PCR done was positive. Patient was managed for hyperglycemic crisis with intravenous normal saline and soluble insulin. She was also commenced on Ribavirin but died of complications of lassa fever. Lassa fever should be included as a precipitant of hyperglycemic crisis in endemic countries.

Case series on tropical diabetic hand syndrome.

Tropical diabetic hand syndrome is a term used to describe diabetes complication of the hand affecting people in the tropics. It consists of localized cellulitis with variable swelling and ulceration of the hands, progressive, fulminant hand sepsis and gangrene in extreme cases. This syndrome is not well-recognized and is therefore less frequently reported. The authors describe three different female patients who were known diabetics of varying duration presenting with this syndrome at our tertiary health center and who were successfully managed by both the surgical and medical units. The need for early diagnosis and aggressive management is emphasized.

Impact of urbanization and gender on frequency of metabolic syndrome among native Abuja settlers in Nigeria.

BACKGROUND: Metabolic syndrome (MetS) is an important cause of morbidity and mortality. Nigeria is currently undergoing rapid epidemiological transition. The objective was to study whether urbanization is associated with increased prevalence of MetS between native rural Abuja settlers and genetically related urban dwellers. MATERIALS AND METHODS: It was a cross-sectional study. Three hundred and forty-two urban native Abuja settlers and 325 rural dwellers were used for the study. Fasting blood lipid, glucose, waist circumference, blood pressure, and body mass index were determined. MetS was defined according to three standard criteria. SPSS 16.0 was used for statistical analysis. P<0.05 was used as statistically significant. RESULTS: Obesity, hypertriglyceridemia, and hypertension were commoner among urban dwellers than rural dwellers. MetS was associated more with the female gender. Urbanization significantly increases the frequency of MetS using the three standard definitions. The prevalence of MetS using International Diabetes Federation, World Health Organization, and National Cholesterol Education Program Adult Treatment Panel III among rural versus urban dwellers were 7.7% vs. 14.9%, P<0.05; 0% vs. 0.9%, P>0.05; and 3.7% vs. 13.7%, P<0.05, respectively. CONCLUSION: This study shows that MetS is a major health condition among rural and urban Nigerians and that urbanization significantly increases the prevalence of MetS. This can be explained on the basis of higher prevalence of dyslipidemia, obesity, and hypertension in urban setting, possibly as a result of stress, diet, and reduction in physical activity. Effective preventive strategy is therefore required to stem the increased risk associated with urbanization to reduce the cardiovascular risk associated with MetS among Nigerians.

Relationships between hemoglobin A 1c and spot glucose measurements in Nigerians with type 2 diabetes mellitus.

BACKGROUND: Glycosylated hemoglobin, HbA 1c is the most acceptable measure of chronic glycemia. It is not widely available and/or affordable in Nigeria. The mean of the monthly fasting plasma glucose (MFPG) of the preceding 3 months is often used as surrogate for assessing chronic glycemia. OBJECTIVE: To determine the relationships among fasting plasma glucose (FPG), 2-hour post-prandial glucose (2-hPG), HbA1c, and MFPG. MATERIALS AND METHODS: Hospital records were used to derive the MFPGs of diabetic subjects from the mean of their monthly FPGs of the preceding three months. Other data extracted included the patient's age, sex, body mass index (BMI), waist circumference (WC), and duration of diabetes mellitus (DMDU). FPG, 2- hPG and HbA 1c were determined during this index consultation. RESULTS: Ninety five persons (65 males, 30 females) with type 2 were included in the study. Their mean age and DMDU were 54.7 ± 8.9 years and 8.1 ± 6.1 years, respectively. Their mean WC, BMI, FPG, 2-hPG, HbA1c, and MFPG were 100.2 ± 11.0 cm, 24.2 ± 4.3 kgm/2, 7.5 ± 2.4 mmol/l, 10.4 ± 4.1 mmol/l, 8.2 ± 2.2%, and 5.9 ± 2.2 mmol/l, respectively. The males were significantly older (57.5 ± 8.4 vs 49.3 ± 7.6, P<0.001) while the females had higher waist circumference and BMI than their male counterparts: 104.8 ± 11.6 cm vs 92.8 ± 10.1 cm, P<0.004; and 25.8 ± 4.9 kg/m 2 vs 23.3 ± 3.7 kg/m 2 , P<0.005, respectively. There were no significant differences in FPG, 2-hPG, MFPG and HbA1c levels between male and female subjects. There were significant positive correlations between FPG and HbA1c (r=0.45, P=0.05) and between 2-hPG and HbA1c (r=0.52, P=0.01), but there was no positive correlation between MFPG and HbA1c (r=-0.20, P=0.18). CONCLUSION: There is no positive correlation between MFPG and HbA 1c and thus MFPG may not be a good surrogate for HbA1c in assessment of chronic glycemia in our patients.

Glycaemic response to some commonly eaten fruits in type 2 diabetes mellitus.

BACKGROUND: It is not known which of the commonly consumed fruits in Nigeria are suitable for persons with diabetes mellitus especially with regards to the attendant plasma glucose response (PGR) to consumption of such fruits. OBJECTIVES: To determine and compare the PGR to commonly eaten fruits in patients with diabetes mellitus. METHODS: Ten persons with type 2 diabetes mellitus were studied. Fifty-gram portions of five fruits containing 50 g carbohydrate [ banana, Musa paradisiaca; orange, Citrus sinensis; pineapple, Ananus comosus; mango, Magnifera indica; pawpaw, Carica papaya], and glucose were randomly fed to the study subjects at one-week intervals. Blood samples were collected in the fasting state and half-hourly over a 2- hour period post-ingestion of the fruits or glucose for plasma glucose determination. Plasma glucose responses were assessed by the peak plasma glucose concentration (PPPG), maximum increase in postprandial plasma glucose (MIPG), two-hour postprandial plasma glucose level (2hPG) and incremental area under the glucose curve (IAUGC). RESULTS: The mean ± SEM PPPG in mmol/L were: banana, 9.0± 1.6; orange, 8.1± 0.8; pineapple, 9.2±1.1; mango, 8.0 ± 1.1; and pawpaw, 7.8±0.9. The mean ±SEM IAUGC in mmol.min/L were: banana, 131.7±53.4; orange, 108.7±29.8; pineapple, 115.3±33.2; mango, 101.6 ± 28.7; and pawpaw, 124.1± 46.1. However, mango showed the least MIPG (1.8 ± 0.5 mmol/l) followed by orange and pawpaw. The IAUGC also followed this pattern. There were no significant differences among the glycaemic indices of the fruits. Glucose load produced a significantly higher IAUGC than the fruits (orange, pineapple, mango, pawpaw, p<0.005; banana, p<0.025). CONCLUSION: The plasma glucose response to consumption of Nigeria fruits are similar. The PGR indices to all fruits were less than the PGR after an equivalent carbohydrate load of glucose. It appears safe to recommend these Nigerian fruits to persons with diabetes within the prescribed daily total calorie intake.

Pregnancy associated with recurrent acromegaly: a case report.

BACKGROUND: Acromegaly is an uncommon endocrine disorder. Pregnancy is an unusual event in acromegalic females because fertility is often reduced. With the advent of advanced surgical and medical management, more acromegalic women will achieve pregnancy. Reports of pregnancy in acromegaly and recurrent acromegaly postpartum are rare. OBJECTIVE: To present a rare occurrence of pregnancy in acromegaly after macroadenectomy and recurrent acromegaly postpartum. METHODS: Clinical and biochemical evaluation of a 39-year-old female Nigerian with features of acromegaly before and after macroadenectomy and postpartum was done. Investigations carried out included oral glucose tolerance test with serial growth hormone assays and insulin-like growth factor 1 as well as computed tomography scan and magnetic resonance imaging of the pituitary. RESULTS: There was a history of menorrhagia, swelling of the feet and increasing coarsening of the facial appearance. She had biochemical evidence of acromegaly and subsequently had a transsphenoidal macroadenectomy. There was postoperative clinical and biochemical remission. Magnetic resonance imaging done six months postsurgery showed no evidence of tumour regrowth. Clinical and biochemical evidence of acromegaly recurred after pregnancy. Magnetic resonance imaging confirmed tumour regrowth. CONCLUSION: Pregnancy in treated acromegaly, though a rare occurrence, is achievable but is capable of provoking recurrence of acromegaly.

Bacteriology of Diabetic Foot Ulcers in Bacteriology; in Benin City; Nigeria

This study aimed to determine the bacteriological pattern and antimicrobial susceptibility of diabetic foot ulcer (DFU) infections seen in our practice; with a view to suggesting optimal therapy for these patients. Forty-seven persons with DFU were seen. The mean age was 56 years. Of these; 30 (64) had wound swabs sent for bacteriological assessment and antibiotic sensitivity patterns. There were 20 non-gangrenous ulcers and 10 gangrenous ulcers. Proteus spp and coliform organisms were the most predominantly isolated organisms in gangrenous ulcers; while Staphylococcus aureus; coliforms; and Pseudomonas aeruginosa were commonly isolated in non-gangrenous ulcers. Grampositive organisms were sensitive to ciprofloxacin (100); gentamicin (100); and perfloxacin (88). Gram-negative organisms were sensitive to ciprofloxacin (74); gentamicin (43); and perfloxacin (39). We conclude that ciprofloxacin and gentamicin are the most effective antibiotics against gram-positive and gram-negative organisms; and thus recommend the combination of ciprofloxacin and/or gentamicin and metronidazole as initial therapy for patients with infected DFU while awaiting culture results