Management of Type 2 Diabetes in Developing Countries: Balancing Optimal Glycaemic Control and Outcomes with Affordability and Accessibility to Treatment.

With the growing prevalence of type 2 diabetes, particularly in emerging countries, its management in the context of available resources should be considered. International guidelines, while comprehensive and scientifically valid, may not be appropriate for regions such as Asia, Latin America or Africa, where epidemiology, patient phenotypes, cultural conditions and socioeconomic status are different from America and Europe. Although glycaemic control and reduction of micro- and macrovascular outcomes remain essential aspects of treatment, access and cost are major limiting factors; therefore, a pragmatic approach is required in restricted-resource settings. Newer agents, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in particular, are relatively expensive, with limited availability despite potentially being valuable for patients with insulin resistance and cardiovascular complications. This review makes a case for the role of more accessible second-line treatments with long-established efficacy and affordability, such as sulfonylureas, in the management of type 2 diabetes, particularly in developing or restricted-resource countries.

Short-term effects of perindopril-amlodipine vs perindopril-indapamide on blood pressure control in sub-Saharan type 2 diabetic individuals newly diagnosed for hypertension: A double-blinded randomized controlled trial.

Poor blood pressure (BP) control contributes to complications in sub-Saharan African (SSA) type 2 diabetic individuals. Experts have advocated the use of combination therapies for effective BP control in these patients. The suggested combinations should include a RAAS antagonist and either a CCB or a thiazide diuretic; however, their efficacy is yet to be established in SSA. We investigated the short-term effects of two combination therapies on BP control in SSA type 2 diabetic individuals. This was a double-blinded randomized controlled trial conducted at the Yaoundé Central Hospital (Cameroon) from October 2016 to May 2017. We included type 2 diabetic patients, newly diagnosed for hypertension. After baseline assessment and 24-hour ABPM, participants were allocated to receive either a fixed combination of perindopril + amlodipine or perindopril + indapamide for 42 days. Data analyses followed the intention-to-treat principle. We included fifteen participants (8 being females) in each group. Both combinations provided good circadian BP control after 6 weeks with similar efficacy. Twenty-four-hour SBP dropped from 144 to 145 mm Hg vs 128 to 126 mm Hg with perindopril-amlodipine and perindopril-indapamide, respectively (P = 0.003 for both groups). Twenty-four-hour DBP dropped from 85 to 78 mm Hg (P = 0.013) vs 89 to 79 mm Hg (P = 0.006) in the same respective groups. No significant adverse effect was reported. A fixed initial combination of perindopril-amlodipine or perindopril-indapamide achieved similar effective BP control after 6 weeks in SSA type 2 diabetic individuals with newly diagnosed hypertension. Therefore, these combinations can be used interchangeably in this indication.

Effect of patient education through a social network in young patients with type 1 diabetes in a Sub-Saharan context.

BACKGROUND: Patient education is essential in management of type 1 diabetes (T1D). OBJECTIVE: To evaluate the short-term impact of patient education through WhatsApp on the knowledge of the disease and glycemic control of adolescents and young adults living with T1D in a resource-limited setting. METHODS: A double arm non-randomized clinical trial was carried out in two clinics for diabetes in Cameroon, over a period of 2 months. The intervention consisted in providing four sessions of patient education through WhatsApp to an intervention group compared to a control group with their classic follow-up. We evaluate their knowledge on diabetes, acute events, and glycemic control, before and after intervention. RESULTS: We recruited 54 patients of which 25 subjects and 29 controls. Median age was 19 (17-20) and 19 (17-21) years for the intervention and control group, respectively. There was a significant improvement of knowledge on diabetes in the intervention group from 13/20 to 16/20 (P < 0.01) after 2 months, compared to a slight decrease in control group (from 11.6/20 to 11.3/20 (P = 0.33). The mean proportion of acute complications decreased from 28% to 16% (P = 0.46) in the intervention group, and increased from 7% to 34%, P = 0.01 in the control group. There was no improvement in glycosylated hemoglobin level in both groups. CONCLUSION: Patient education through social network helped to improve knowledge on T1D and to reduce acute complications without an improvement of glycemic control after 2 months.

Resource use associated with type 2 diabetes in Africa, the Middle East, South Asia, Eurasia and Turkey: results from the International Diabetes Management Practice Study (IDMPS).

OBJECTIVE: Type 2 diabetes (T2D) and its complications form a global healthcare burden but the exact impact in some geographical regions is still not well documented. We describe the healthcare resource usage (HRU) associated with T2D in Africa, the Middle East, South Asia, Eurasia and Turkey. RESEARCH DESIGN AND METHODS: In the fifth wave of the International Diabetes Management Practices Study (IDMPS; 2011-2012), we collected self-reported and physician-reported cross-sectional data from 8156 patients from 18 countries across 5 regions, including different types of HRU in the previous 3-6 months. Negative binomial regression was used to identify parameters associated with HRU, using incidence rate ratios (IRRs) to express associations. RESULTS: Patients in Africa (n=2220), the Middle East (n=2065), Eurasia (n=1843), South Asia (n=1195) and Turkey (n=842) experienced an annual hospitalization rate (mean±SD) of 0.6±1.9, 0.3±1.2, 1.7±4.1, 0.4±1.5 and 1.3±2.7, respectively. The annual number of diabetes-related inpatient days (mean±SD) was 4.7±22.7, 1.1±6.1, 16.0±30.0, 1.5±6.8 and 10.8±34.3, respectively. Despite some inter-regional heterogeneity, macrovascular complications (IRRs varying between 1.4 and 8.9), microvascular complications (IRRs varying between 3.4 and 4.3) and, to a large extent, inadequate glycemic control (IRRs varying between 1.89 and 10.1), were independent parameters associated with hospitalization in these respective regions. CONCLUSIONS: In non-Western countries, macrovascular/microvascular complications and inadequate glycemic control were common and important parameters associated with increased HRU.

The effect of Spirulina platensis versus soybean on insulin resistance in HIV-infected patients: a randomized pilot study.

UNLABELLED: HIV-infected patients develop abnormalities of glucose metabolism due to the virus and antiretroviral drugs. Spirulina and soybean are nutritional supplements that are cheap, accessible in our community and affect glucose metabolism. We carried out a randomized study to assess the effect of Spirulina platensis versus soybean as a food supplement on HIV/HAART-associated insulin resistance (IR) in 33 insulin-resistant HIV-infected patients. The study lasted for two months at the National Obesity Centre of Cameroon. Insulin resistance was measured using the short insulin tolerance test. Physical activity and diet did not change over the study duration. On-treatment analysis was used to analyze data. The Mann-Whitney U test, the Students T test and the Chi square test were used as appropriate. Curve gradients were analyzed using ANCOVA. Seventeen subjects were randomized to spirulina and 16 to soybean. Each received 19 g of supplement daily. The follow up rate was 65% vs. 100% for spirulina and soybean groups, respectively, and both groups were comparable at baseline. After eight weeks, insulin sensitivity (IS) increased by 224.7% vs. 60% in the spirulina and soybean groups respectively (p < 0.001). One hundred per cent vs. 69% of subjects on spirulina versus soybean, respectively, improved their IS (p = 0.049) with a 1.45 (1.05-2.02) chance of improving insulin sensitivity on spirulina. This pilot study suggests that insulin sensitivity in HIV patients improves more when spirulina rather than soybean is used as a nutritional supplement. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01141777.

Predicting physical activity energy expenditure using accelerometry in adults from sub-Sahara Africa.

Lack of physical activity may be an important etiological factor in the current epidemiological transition characterized by increasing prevalence of obesity and chronic diseases in sub-Sahara Africa. However, there is a dearth of data on objectively measured physical activity energy expenditure (PAEE) in this region. We sought to develop regression equations using body composition and accelerometer counts to predict PAEE. We conducted a cross-sectional study of 33 adult volunteers from an urban (n = 16) and a rural (n = 17) residential site in Cameroon. Energy expenditure was measured by doubly labeled water (DLW) over a period of seven consecutive days. Simultaneously, a hip-mounted Actigraph accelerometer recorded body movement. PAEE prediction equations were derived using accelerometer counts, age, sex, and body composition variables, and cross-validated by the jack-knife method. The Bland and Altman limits of agreement (LOAs) approach was used to assess agreement. Our results show that PAEE (kJ/kg/day) was significantly and positively correlated with activity counts from the accelerometer (r = 0.37, P = 0.03). The derived equations explained 14-40% of the variance in PAEE. Age, sex, and accelerometer counts together explained 34% of the variance in PAEE, with accelerometer counts alone explaining 14%. The LOAs between DLW and the derived equations were wide, with predicted PAEE being up to 60 kJ/kg/day below or above the measured value. In summary, the derived equations performed better than existing published equations in predicting PAEE from accelerometer counts in this population. Accelerometry could be used to predict PAEE in this population and, therefore, has important applications for monitoring population levels of total physical activity patterns.