Undiagnosed depression among adults with diabetes mellitus in Jos.

BACKGROUND: Diabetes mellitus (DM) and depression are common chronic disease states of public health importance with huge burden and the potential to impact many aspects of life. They are said to be related though this relationship is not fully understood. The presence of depression among patients with DM is associated with poor glycemic control, complications, and poor self-care. METHOD: This was a descriptive cross-sectional study conducted at the Diabetes Clinic of the Jos University Teaching Hospital. Three hundred and ten (310) patients with diabetes mellitus were recruited consecutively. The depression module of the Mini International Neuropsychiatric Interview (M.I.N.I.) version 5.0 was used to ascertain depression among these patients. Other demographic data were obtained using a questionnaire. Blood pressure, weight, and height were also measured and the body mass index (BMI) calculated. RESULTS: One hundred and eighty four (59.35%) of the study population were females and the mean age (SD) of the study population was 54 ± 12 years. The mean age (SD) of the females was 53 ± 11 years and that of the males was 54 ± 12 years with no significant statistical difference (P = 0.35). Two hundred and forty nine (80.32%) of the study population were urban dwellers with 140 (45.16%) earning less than N500, 000 (794 USD) yearly. Current major depression was found in 35 (11.3%) patients, among whom 7 (2.3%) had recurrent depression. The presence of DM complications (OR: 3.50, 95% CI 1.16-10.61) and a positive family history of depression (OR: 4.03, 95% CI 1.32-12.29) were found to be correlates of current major depression. CONCLUSION: The prevalence of current major depression among patients with diabetes mellitus in this study is high. We recommend that all patients with DM should be screened for depression and treated appropriately to reduce its consequences.

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa.

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

Prevalence of overweight and obesity in Maiduguri, North-Eastern Nigeria.

BACKGROUND: The prevalence of obesity is on the increase worldwide including in many developing countries. There is no report on the magnitude of obesity among adults in Maiduguri, a major city in northeastern Nigeria. MATERIALS AND METHODS: We selected a sample of 1650 men and women aged 15 years and above resident in Gwange ward in Maiduguri metropolitan council using a multistage sampling technique. Height, weight, waist (WC) and hip circumferences w measured. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Data were analyzed using SPSS version13. The ethics committee of the University of Maiduguri Teaching Hospital approved the study and consent was sought individually from the participants before being enlisted. RESULTS: The mean (SD) age of the respondents was 36.2 (14.4) years, with a range of 15 to 70 years. The mean (SD) ages of the males and females were 34.9 4.3) and 38.9 (14.0) years, respectively, (p < 0.001). The overall crude prevalence rates of overweight and obesity were 27.1% and 17.1%, respectively. In men, 40.6% were either overweight or obese, while in women 51.9% were either overweight or obese. We observed the highest prevalence rates of overweight and obesity in the middle age group. There were more obese females than males (14.05 vs. 4.3%) among both young and elderly (12.1% vs. 10.5%) subjects. CONCLUSION: The prevalence of overweight and obesity is high in Maiduguri metropolis particularly among women. Concerted efforts should be made to curb the menace of increasing rate of obesity in the metropolis through public enlightenment on the risks associated with obesity and the benefits of adopting a healthy lifestyle.

Chronic kidney disease screening and renoprotection in type 2 diabetes.

BACKGROUND: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. METHODS: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. RESULTS: Urinalysis was done in 49.1% and serum creatinine in 50.3%. No patient had glomerular filtration rate estimated. Seventy nine (67.6%) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8%) of these patients BP control was optimal in 29.1%. CONCLUSION: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D.

Chronic Kidney Disease Screening and Renoprotection in Type 2 Diabetes

Background: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. Methods: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. Results: Urinalysis was done in 49.1and serum creatinine in 50.3. No patient had glomerular filtration rate estimated. Seventy nine (67.6) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8) of these patients BP control was optimal in 29.1. Conclusion: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D

Prevalence of risk factors for diabetes mellitus in a non-diabetic population in Jos, Nigeria.

BACKGROUND: Diabetes mellitus (DM) is assuming epidemic proportions worldwide, but probably more so in the developing world. Identification of risk factors for the development of type 2 diabetes mellitus is a necessary step in planning prevention programmes for diabetes mellitus. The objective of this study was to determine the frequency of risk factors for type 2 DM among inhabitants of Jos, a northern city on the Nigerian Plateau. METHOD: A district in central Jos was randomly picked. Census of the district was carried out to record the names of all eligible residents from 250 households selected systematically. A questionnaire was administered by trained interviewers. Socio-demographic data, family history of diabetes, and data on work related physical activity were recorded. Height, weight and waist and hip circumferences were also measured. BMI (kg/m2) and waist-hip ration were calculated. RESULTS: Of 902 subjects (= 15years of age), 825 (91.5%) responded. The mean (SD) age of 400 males and 422 females were respectively 36.4 (15.2) and 39.9 (17.3) years. About 50% of the respondents were inactive. 435 (52.7%) were currently taking alcohol. Twenty nine (3.5%) of the subjects admitted to parental history of DM. 177 (21.4%) were either overweight or obese. 32% of males and 86% of females had abnormal waist circumferences (WCE). 96 (23.8%) males and 316(74.9%) females had abnormal WHR. BMI correlated strongly and significantly with WHR (r = 0.64, p < 0.001) and WCE (r = 0.72, p < 0.001). CONCLUSION: Inactivity alcohol usage and excess weight appear to be dominant risk factors for development of type 2 DM in this group of upland Nigerians.

Primary hyperparathyroidism presenting with severe hypertension in a middle aged Nigerian--a case report.

OBJECTIVE: To draw attention to primary hyperparathyroidism as a cause of severe hypertension. RESULTS: A 47 year old Nigerian male presented with headache, occasional blurring of vision and dyspnoea on mild exertion of 2/12 duration. He had been troubled by painful osteoarthritis of the knees for 2 years for which he was taking NSAIDs. He was found to be severely hypertensive, BP 210/130mmHg and had bilateral knee crepitus. BP was resistant to control on Nifedipine R and Moduretic. Serum urea, creatinine, uric acid were normal but there was hyperacalcaemia and hyperchloraemia. Haematological indices, urinalysis, microscopy and culture of urine were normal. Parathyroid hormone level was raised. A parathyroid MIBI scan study showed an extensive area of significance towards the inferior pole of the right lobe of thyroid medially with a second area of very low significance medial to the left pole. These findings indicated the presence of a right inferior parathyroid adenoma. He had parathyroid surgery and a large adenoma in the right inferior gland and a smaller left inferior gland were removed and confirmed histologically. Corrected calcium and parathyroid hormone levels dropped to normal, and the BP was easily controlled with Lisinopril 5mg daily subsequently. He is not currently on antihypertensive medication two years post surgery. CONCLUSION: This case highlights the need for thorough investigation of cases of hypertension to exclude specifically secondary causes, which in some cases may be endocrine in origin and may easily be corrected.

Prevalence of Risk Factors for Diabetes Mellitus in A Non-Diabetic Population in Jos; Nigeria

Background: Diabetes mellitus (DM) is assuming epidemic proportions worldwide; but probably more so in the developing world. Identification of risk factors for the development of type 2 diabetes mellitus is a necessary step in planning prevention programmes for diabetes mellitus. The objective of this study was to determine the frequency of risk factors for type 2 DM among inhabitants of Jos; a northern city on the Nigerian Plateau. Method: A district in central Jos was randomly picked. Census of the district was carried out to record the names of all eligible residents from 250 households selected systematically. A questionnaire was administered by trained interviewers. Socio-demographic data; family history of diabetes; and data on work related physical activity were recorded. Height; weight and waist and hip circumferences were also measured. BMI (kg/m2) and waist-hip ration were calculated. Results: Of 902 subjects (? 15years of age); 825 (91.5) responded. The mean (SD) age of 400 males and 422 females were respectively 36.4 (15.2) and 39.9 (17.3) years. About 50of the respondents were inactive. 435 (52.7) were currently taking alcohol. Twenty nine (3.5) of the subjects admitted to parental history of DM. 177 (21.4) were either overweight or obese. 32of males and 86of females had abnormal waist circumferences (WCE). 96 (23.8) males and 316 (74.9) females had abnormal WHR. BMI correlated strongly and significantly with WHR (r = 0.64; p 0.001) and WCE (r Conclusion: Inactivity; alcohol usage and excess weight appear to be dominant risk factors for development of type 2 DM in this group of upland Nigerians

Dupuytren's contracture in a patient with type 2 diabetes mellitus--a case report.

BACKGROUND: Dupuytren's contracture is one of the manifestations of the hand syndrome in diabetes mellitus (DM). Its occurrence in diabetes mellitus is not commonly reported in this environment. This report aims to highlight the occurrence of Dupuytren's contracture as a rare manifestation of diabetic hand syndrome in a patient with type 2 DM. METHOD: The case note of a patient with type 2 DM who developed Dupuytren's contracture in both hands and the available literature on the subject were reviewed. RESULT: A 62-year-old Nigerian male Islamic Cleric with type 2 DM for sixteen years on follow-up at the Diabetes clinic of the Jos University Teaching Hospital (JUTH), Jos, developed flexion deformity involving both palms. His symptoms had progressed gradually over the preceding nine months before presentation. Physical examination revealed bilateral Dupuytren's contracture of the palms with hyperkeratosis and flexion deformities of the fingers. He was admitted to the surgical ward of JUTH and had surgery in the right hand. He is to have surgery in the left hand on a later date. CONCLUSION: Dupuytren's contracture is a rare presentation of diabetic hand syndrome. A careful hand examination by physicians in all DM patients for early diagnosis and treatment is recommended.

Prevalence of microalbuminuria in newly diagnosed type 2 diabetic patients in Jos Nigeria.

Diabetic nephropathy contributes significantly to end-stage renal disease in Nigeria. The earliest clinically detectable stage is that of microalbuminuria when interventions could halt or retard the progression to end-stage renal disease. To investigate the prevalence of microalbuminuria in newly diagnosed type 2 diabetic patients and its clinical correlates in Jos, consecutive patients with newly diagnosed type 2 diabetes attending two large hospitals in Jos were evaluated at three different occasions of monthly intervals for microalbuminuria using Micral test strips 11. Patients with proteinuria, positive nitrite test/ urine microbial culture, acute illnesses or cardiac decompensation were excluded. Out of a total of 99 patients recruited, only 65 completed the study. Microalbuminuria was present in 32(49.2%) of the patients, and was significantly associated with mean arterial pressure, systemic hypertension and diabetic retinopathy (P < 0.05). Microalbuminuria is common in newly diagnosed patients with type 2 diabetes mellitus. Our finding supports routine screening for microalbuminuria as part of the initial evaluation of these patients.

Some metabolic abnormalities in type 2 diabetic patients in Jos, north central Nigeria.

BACKGROUND: Diabetes mellitus is associated with derangements in the serum levels of several biochemical parameters. This study was conducted in an attempt to obtain the biochemical profiles and their abnormalities in Nigerian type 2 diabetic patients in Jos, North Central Nigeria. METHODS: Seventy-five (75) Nigerians with type 2 diabetes mellitus and 69 age and sex-matched non-diabetic controls were investigated. Each participant had fasting plasma glucose, plasma lipids, liver, renal function profiles as well as their clinical characteristics assessed. RESULTS: The clinical characteristics body mass index, waist hip ratio and blood pressures were significantly higher in diabetics than controls (p < 0.05). Renal and lipid profiles were also significantly higher in diabetics. There was no significant difference in the liver profile between diabetics and controls. Diabetics with good glycaemic control had lower frequencies of biochemical abnormalities compared to diabetics with poor control. CONCLUSION: Metabolic abnormalities are common in Nigerians with type 2 diabetes. Our findings support the fact that controlling hyperglycaemic state would be beneficial in preventing the major metabolic abnormalities and hence the complications of diabetes mellitus.