Prevalence and covariates of electrocardiographic left ventricular hypertrophy in diabetic patients in Tanzania.

BACKGROUND: Left ventricular hypertrophy (LVH) has been demonstrated to be a powerful predictor of cardiovascular (CV) morbidity and mortality in diabetic as well as hypertensive patients. However, less is known about the prevalence of electrocardiographic LVH (ECG-LVH) and its relation to other CV risk factors in diabetic patients in sub-Saharan Africa. Therefore, the aim was to assess the prevalence of ECG-LVH in diabetic patients in Dares Salaam, Tanzania, and its relation to other cardiovascular risk factors. METHODS: Two hundred and thirty-seven consecutive patients attending the Muhimbili diabetic clinic were studied. ECG-LVH was diagnosed by Sokolow-Lyon voltage and Cornell voltage-duration product criteria. Q waves, ST-segment deviation, T-wave abnormalities and intraventricular conduction defects were classified by the Minnesota codes. Blood pressure (BP), serum creatinine, cholesterol and triglyceride levels, and HbA 1c and urinary albumin and creatinine concentrations were determined. RESULTS: The prevalence of LVH in patients was 16% by either ECG criteria; 12.2% by Sokolow-Lyon and 5.1% by Cornell product criteria. Patients with LVH had significantly higher systolic and mean BP and pulse pressure, and a higher prevalence of ST-segment abnormalities, T-wave inversion and albuminuria than those without LVH (all p < 0.05). In multivariate logistic regression analysis, systolic BP was the only independent predictor of ECG-LVH. The prevalence of ECG-LVH increased by 15% per 10 mmHg higher systolic BP [OR 1.151 (95% CI 1.009-1.314), p < 0.05]. Clustering of cardiovascular risk factors differed significantly between type 1 and type 2 diabetes patients. On average, type 1 patients had 0.8 and type 2 had 2.2 additional CV risk factors. CONCLUSION: ECG-LVH was present in 16% of diabetic patients in Tanzania. Systolic BP was the most important predictor of ECG-LVH. Clustering of CV risks was significantly higher in type 2 than in type 1 diabetics, demonstrating the need for systematic multiple risk-factor assessment in these patients.

Prevalence and Covariates of Electrocardiographic Left Ventricular Hypertrophy in Diabetic Patients in Tanzania : Cardiovascular Topics

Background : Left ventricular hypertrophy (LVH) has been demonstrated to be a powerful predictor of cardiovascular (CV) morbidity and mortality in diabetic as well as hypertensive patients. However; less is known about the prevalence of electrocardiographic LVH (ECG-LVH) and its relation to other CV risk factors in diabetic patients in sub-Saharan Africa. Therefore; the aim was to assess the prevalence of ECG-LVH in diabetic patients in Dar es Salaam; Tanzania; and its relation to other cardiovascular risk factors. Methods: Two hundred and thirty-seven consecutive patients attending the Muhimbili diabetic clinic were studied. ECGlvH was diagnosed by Sokolow-Lyon voltage and Cornell voltage-duration product criteria. Q waves; ST-segment deviation; T-wave abnormalities and intraventricular conduction defects were classified by the Minnesota codes. Blood pressure (BP); serum creatinine; cholesterol and triglyceride levels; and HbA1c and urinary albumin and creatinine concentrations were determined. Results: The prevalence of LVH in patients was 16by either ECG criteria; 12.2by Sokolow-Lyon and 5.1by Cornell product criteria. Patients with LVH had significantly higher systolic and mean BP and pulse pressure; and a higher prevalence of ST-segment abnormalities; T-wave inversion and albuminuria than those without LVH (all p 0.05). in multivariate logistic regression analysis; systolic BP was the only independent predictor of ECG-LVH. The prevalence of ECG-LVH increased by 15per 10 mmHg higher systolic BP [OR 1.151 (95CI 1.00921.314); p 0.05]. Clustering of cardiovascular risk factors differed significantly between type 1 and type 2 diabetes patients. On average; type 1 patients had 0.8 and type 2 had 2.2 additional CV risk factors. Conclusion: ECG-LVH was present in 16of diabetic patients in Tanzania. Systolic BP was the most important predictor of ECG-LVH. Clustering of CV risks was significantly higher in type 2 than in type 1 diabetics; demonstrating the need for systematic multiple risk-factor assessment in these patients

Islet cell autoantibodies in African patients with Type 1 and Type 2 diabetes in Dar es Salaam Tanzania: a cross sectional study.

BACKGROUND: The aim of the present study was to assess the occurrence of glutamic acid decarboxylase autoantibodies (GADA) and insulinoma antigen 2 autoantibodies (IA2A) among patients of African origin in Dar es Salaam, Tanzania and to compare the occurrence of autoimmune mediated Type 1 diabetes with findings previously reported from the same place and from other African diabetic populations. METHODS: Two hundred and forty five patients from the diabetic clinic at Muhimbili Hospital were recruited for a cross sectional study. Patients were clinically classified into groups with Type 1 (T1D) and Type 2 diabetes (T2D); there were 94 patients with T1D and 151 with T2D. Autoantibodies for GAD and IA2 were measured with an assay based on radioligand binding. Fasting and random blood glucose, HbA1c, and C-peptide levels were also determined. RESULTS: Of the patients with T1D, 28 (29.8%) were GADA positive and 20 (21.3%) were IA2A positive. The overall occurrence of any autoantibody was 42.6%. The GAD and IA2 autoantibodies were detected more frequently among patients with T1D than among patients with T2D (P < 0.001). A higher autoantibody prevalence was observed with combined GADA and IA2A measurements compared to individual autoantibody measurements; 40 (42.6%) patients with T1D versus 11 (7.3%) with T2D had at least one positive autoantibody titer. There was no correlation between duration of disease and detection of autoantibodies in patients with T1D. There was a strong association with family history of diabetes among the autoantibody positive versus autoantibody negative patients with T1D (p < 0.01). CONCLUSION: The prevalence of GAD and IA2 autoantibodies among African patients with T1D in Dar es Salaam was the same as that reported previously for South Africa and Ethiopia. It was much higher than the prevalence of islet cell autoantibodies (ICA) reported from the same clinic about 15 years ago. For unknown reasons the prevalence of pancreatic related autoantibodies in this African population is lower than the prevalence found among Caucasian populations.

The effect of Phyllanthus amarus aqueous extract on blood glucose in non-insulin dependent diabetic patients.

The glycaemic response to 124.5 +/- 9.3 (mean +/- SD) g of pancakes was monitored in 21 non-insulin dependent diabetic (NIDDM) patients while on oral hypoglycaemics, after a 1-week washout period and after a 1-week twice daily treatment with 100 mL of an aqueous extract from 12.5 g of powdered aerial parts of Phyllanthus amarus. After the 1-week washout period, the fasting blood glucose (FBG) and postprandial blood glucose increased significantly compared with treatment on oral hypoglycaemics ( p < 0.05). After a 1-week herbal treatment no hypoglycaemic activity was observed. Both FBG and postprandial blood glucose remained very similar to that recorded after the washout period ( p > 0.05). Both liver and renal functions based on alanine transaminase (ALAT) and serum creatinine, respectively, were not significantly affected by the use of the extract. Although the lymphocyte and monocyte levels were significantly decreased ( p < 0.05) and the granulocyte level was significantly increased after treatment ( p < 0.05) the overall total white blood cell (WBC) count and haemoglobin (Hb) were not significantly affected by the 1 week herbal treatment. We conclude that 1 week treatment with the aqueous extract of Phyllanthus amarus was incapable of lowering both FBG and postprandial blood glucose in untreated NIDDM patients.