Assessing the Burden of Kidney Disease among Type 2 Diabetic Subjects Attending a Semi-Urban Tertiary Health Facility in South-West Nigeria.

BACKGROUND AND OBJECTIVES: Diabetes Mellitus (DM) remains an important public health issue and its complications are important causes of morbidity and mortality. Diabetic nephropathy (DN) is one of these complications and could be prevented/delayed by early detection. This study determined the burden of DN among patients with type 2 diabetes (T2DM). METHODS: This cross-sectional, hospital-based study was conducted among 100 T2DM patients attending the medical outpatient clinics of a tertiary hospital in Nigeria and 100 age- and sex-matched healthy controls. The procedure included collection of sociodemographic parameters, urine for microalbuminuria and blood samples for estimation of fasting plasma glucose, glycated haemoglobin (HbA1c), and creatinine. Estimated creatinine clearance (eGFR) was derived from two formulae - Cockroft Gault formula, and Modification of Diet in Renal Disease study (MDRD) for staging chronic kidney disease. Data were analysed using the IBM SPSS version 23 software. RESULTS: Participants' ages ranged from 28 years to 73 years [mean 53.0 (±10.7) years] with males accounting for 56% of the population and females 44%. Mean HbA1c was 7.6 (±1.8) % among the subjects; 59% had poor glycaemic control with HbA1c >7% (p-value <0.001). Overt proteinuria was present in 13% of T2DM participants while 48% had microalbuminuria compared to the non-diabetic group where 2% had overt proteinuria and 17% had microalbuminuria. Using the eGFR, chronic kidney disease was present in 14% of T2DM group and in 6% of the non-diabetic population. Increased age [OR= 1.09; 95%CI (1.03-1.14)], male sex [OR = 3.50; 95%CI (1.13 10.88)], and duration of diabetes [OR =1.01; 95%CI (1.00-1.01)] were associated with DN. CONCLUSION: The burden of diabetic nephropathy is high in the T2DM patients attending our clinic and this is linked with advancing age.

CONTEXTE ET OBJECTIFS: Le diabète sucré (DM) reste un problème de santé publique important, et ses complications sont des causes importantes de morbidité et de mortalité. La néphropathie diabétique (DN) est l'une de ces complications et pourrait être évitée/ retardée par une détection précoce. Cette étude a déterminé le poids de la néphropathie diabétique chez les patients atteints de diabète detype 2 (DT2). MÉTHODES: Cette étude transversale en milieu hospitalier a été menée auprès de 100 patients atteints de diabète de type 2 fréquentant les consultations médicales externes d'un hôpital tertiaire au Nigeria, et de 100 témoins sains appariés selon l'âge et le sexe. La procédure comprend la collecte de paramètres sociodémographiques, d'urine pour la microalbuminurie et d'échantillons de sang pour l'estimation de la glycémie à jeun, de l'hémoglobine glyquée (HbA1c) et de la créatinine. La clairance estimée de la créatinine (eGFR) a été calculée à partir de deux formules : i) la formule de Cockroft Gault ii) l'étude de Modification de diète en maladie rénale (MDRD) pour la stadification de l'insuffisance rénale chronique. Les données ont été analysées à l'aide du logiciel IBM SPSS version 23. RÉSULTATS: Les participants étaient âgés de 28 à 73 ans [moyenne 53,0 (±10,7) ans], les hommes représentant 56 % de la population et les femmes 44 %. L'HbA1c moyenne était de 7,6 (±1,8) % chez les sujets ; 59 % avaient un mauvais contrôle glycémique avec une HbA1c >7 % (valeur p <0,001). Une protéinurie manifeste était présente chez 13 % des participants atteints de DT2, tandis que 48 % présentaient une microalbuminurie, par rapport au groupe non diabétique, où 2 % présentaient une protéinurie manifeste et 17 % une microalbuminurie. En utilisant le DFGe, la maladie rénale chronique était présente chez 14 % du groupe DT2 et chez 6 % de la population non diabétique. L'âge élevé [OR= 1,09 ; 95%CI (1,03 - 1,14)], le sexe masculin [OR = 3,50 ; 95%CI (1,13 - 10,88)] et la durée du diabète [OR =1,01 ; 95%CI (1,00 - 1,01)] étaient associés à la DN. CONCLUSION: Le fardeau de la néphropathie diabétique est élevé chez les patients atteints de DT2 qui fréquentent notre clinique et ceci est lié à l'âge avancé. Mots-clés: Maladie rénale diabétique, Complications du diabète, Diabète de type 2, Durée du diabète, Âge, Hypertension.

Hyperglycaemic Emergencies are Associated with Increased Pro-inflammatory Cytokine (Interleukin-6) and Cortisol.

BACKGROUND: Cortisol, a counter-regulatory hormone, has been implicated in the pathogenesis of metabolic disturbance in patients with diabetes, and high levels of cortisol have been reported in relation to blood glucose. Elevated blood glucose has been shown to stimulate production of pro-inflammatory cytokines such as interleukin-6 (IL-6). AIM: We set out to investigate pro-inflammatory cytokine (Interleukin-6 [IL-6]) and counter-regulatory hormone (cortisol) and their relationship with outcome in patients with HE in a Nigerian hospital. METHODS: This descriptive, cross-sectional study involved 67 patients with HE and 67 age-, sex-, and body mass index (BMI)-matched diabetic patients without HE who served as controls. Clinical findings and laboratory parameters including IL-6 and cortisol were compared between subjects and controls. RESULTS: Mean serum cortisol and interleukin-6 were significantly higher in HE subjects compared with diabetic non-HE controls (26.9 ±13.1 vs 9.4 ± 1.8µg/dl, 24.0 ± 8.5 vs 8.1 ± 4.1pg/ml, respectively). There was a significant drop in the values of cortisol and IL-6 at resolution of HE. Mean cortisol and IL-6 were significantly higher in HE patients with a fatal outcome compared with HE survivors (46.9±5.6 vs 25.3±12.1 µg/dl, 45.2±2.2 vs 22.3±6.2 pg/ml, respectively). Serum Cortisol correlated positively with total insulin dose required to resolve HE. CONCLUSION: Hyperglycaemia in Nigerians with HE is associated with more profound inflammatory response characterized by higher interleukin-6 and cortisol and a worse outcome compared with levels at resolution of HE and in non-HE diabetic controls. Perhaps, treatment targeting this heightened response may be beneficial to the management of HE.

CONTEXTE: Le cortisol, une hormone de contre-régulation, a été impliqué dans la pathogenèse des troubles métaboliques chez les patients diabétiques, et des taux élevés de cortisol ont été signalés en relation avec la glycémie. Il a été démontré que l'élévation de la glycémie stimule la production de cytokines pro-inflammatoires telles que l'interleukine-6 (IL-6). OBJECTIF: Nous avons entrepris d'étudier la cytokine proinflammatoire (Interleukine-6 [IL-6]) et l'hormone de contrerégulation (cortisol) et leur relation avec le résultat chez les patients atteints d'HE dans un hôpital nigérian. Méthodes: Cette étude descriptive et transversale a porté sur 67 patients atteints d'HE et 67 patients diabétiques sans HE, appariés selon l'âge, le sexe et l'indice de masse corporelle (IMC), qui ont servi de témoins. Les résultats cliniques et les paramètres de laboratoire, notamment l'IL-6 et le cortisol, ont été comparés entre les sujets et les témoins. RÉSULTATS: Le cortisol et l'interleukine-6 sériques moyens étaient significativement plus élevés chez les sujets atteints d'HE que chez les témoins diabétiques sans HE (26,9 ± 13,1 contre 9,4 ± 1,8µg/dl, 24,0 ± 8,5 contre 8,1 ± 4,1pg/ml, respectivement). Il y avait une baisse significative des valeurs de cortisol et d'IL-6 à la résolution de l'HE. Les valeurs moyennes du cortisol et de l'IL-6 étaient significativement plus élevées chez les patients atteints d'HE dont l'issue était fatale par rapport aux survivants de l'HE (46,9±5,6 vs 25,3±12,1 µg/dl, 45,2±2,2 vs 22,3±6,2 pg/ml, respectivement). Le cortisol sérique était corrélé positivement avec la dose totale d'insuline nécessaire pour résoudre l'HE. CONCLUSION: L'hyperglycémie chez les Nigérians atteints d'HE est associée à une réponse inflammatoire plus profonde caractérisée par une interleukine-6 et un cortisol plus élevés et à un résultat plus mauvais par rapport aux niveaux de résolution de l'HE et aux contrôles diabétiques sans HE. Peut-être qu'un traitement ciblant cette réponse accrue pourrait être bénéfique pour la gestion de l'HE. MOTS CLÉS: Urgences hyperglycémiques, Cytokines, Hormones de contre-régulation, Interleukine-6, Cortisol.

Screening for Diabetes Mellitus and Hypertension in Ile-Ife - A World Diabetes Day Experience.

BACKGROUND AND OBJECTIVES: Non-communicable diseases have emerged as major public health concerns in developing nations, where communicable diseases used to be the major contributor to the public health burden. Diabetes and hypertension contribute significantly to this menace, and they are largely undiagnosed in the affected population. We determined the prevalence of previously diagnosed and undiagnosed hypertension and diabetes mellitus in adult Nigerians. METHODS: Participants who presented in response to advertisement for the study and gave informed consent were recruited using convenience sampling. Data was collected using a proforma to obtain salient medical and social history. Anthropometric and blood pressure measurements were done. Capillary blood was taken for initial glucose measurements. Oral glucose tolerance test (OGTT) was subsequently done in non-diabetics with elevated blood glucose to confirm the diagnosis of diabetes. RESULTS: One hundred and thirty-six participants with age range 24 - 90 years were recruited for the study. Participants were mainly females (61.8%). Prevalence of diabetes among study participants was 19.9% (previously diagnosed -16.9% vs undiagnosed - 3.0%) with higher occurrence among males. Hypertension was found in 50.7% of participants; 28.7% were on treatment for hypertension, while 22.0% were newly diagnosed. Diabetes was associated with older age and elevated systolic blood pressure while hypertension was associated with older age, obesity and elevated blood glucose. CONCLUSION: This study showed a high occurrence of diabetes and hypertension among adult Nigerians; hence efforts to address these should be intensified. Targeted screening of people at risk for non-communicable diseases is an added benefit.

CONTEXTE ET OBJECTIFS: Les maladies non transmissibles sont devenues des problèmes de santé publique majeurs dans les pays en développement, où les maladies transmissibles étaient autrefois le principal contributeur au fardeau de la santé publique. Le diabète et l'hypertension contribuent de manière significative à cette menace, et ils ne sont en grande partie pas diagnostiqués dans la population touchée. Nous avons déterminé la prévalence de l'hypertension et du diabète sucré précédemment diagnostiqués et non diagnostiqués chez les Nigérians adultes. MÉTHODES: Les participants qui se sont présentés en réponse à l'annonce de l'étude et ont donné leur consentement éclairé ont été recrutés à l'aide d'un échantillonnage de convenance. Les données ont été recueillies à l'aide d'un formulaire pour obtenir les antécédents médicaux et sociaux saillants. Des mesures anthropométriques et de pression artérielle ont été effectuées. Du sang capillaire a été prélevé pour les mesures initiales de glucose. Un test de tolérance au glucose par voie orale (OGTT) a ensuite été effectué chez des non-diabétiques présentant une glycémie élevée pour confirmer le diagnostic de diabète. RÉSULTATS: Cent trente-six participants âgés de 24 à 90 ans ont été recrutés pour l'étude. Les participants étaient principalement des femmes (61,8%). La prévalence du diabète chez les participants à l'étude était de 19,9% (diagnostiqué précédemment ­16,9% vs non diagnostiqué - 3,0%) avec une fréquence plus élevée chez les hommes. L'hypertension a été trouvée chez 50,7% des participants; 28,7% étaient sous traitement contre l'hypertension, tandis que 22,0% étaient nouvellement diagnostiqués. Le diabète était associé à un âge plus avancé et à une pression artérielle systolique élevée, tandis que l'hypertension était associée à un âge plus avancé, à l'obésité et à une glycémie élevée. CONCLUSION: Cette étude a montré une fréquence élevée de diabète et d'hypertension chez les Nigérians adultes; par conséquent, les efforts pour y remédier devraient être intensifiés. Un dépistage ciblé des personnes à risque de maladies non transmissibles est un avantage supplémentaire.

Relationship between Renal Doppler Indices and Biochemical indices of Renal Function in Type 2 Diabetes Mellitus.

OBJECTIVES: Diabetic nephropathy is a common complication of diabetes mellitus due to microangiopathy leading to end stage renal disease. This study determined the relationship between renal resistivity index and pulsatility index with biochemical indices of renal function in patients with type 2 diabetes mellitus methods: This study involved 80 adults with type 2 diabetes mellitus. Urinary albumin excretion rate (UAER) and serum creatinine levels were measured, and the estimated glomerular filtration rate (eGFR) was calculated. Right renal resistivity index (RI) and pulsatility index (PI) values were determined. RESULTS: Mean renal resistivity index was 0.72±0.06 while the pulsatility index was 1.36 ± 0.24. Resistivity index was positively correlated with albuminuria (r = 0.426; p <0.001) and serum creatinine (r = 0.458; p <0.001), but negatively correlated with eGFR (r = -0.399; p <0.001). There was positive correlation between pulsatility index and albuminuria (r = 0.341; p = 0.002), and serum creatinine (r = 0.478; p = <0.001); and negative correlation between PI and eGFR (r = - 0.359; p = 0.001). CONCLUSIONS: Renal resistivity index and pulsatility index may provide valuable non-invasive estimate of predicting the presence and severity of renal dysfunction in patients with type 2 diabetes.

Declining prevalence of duodenal ulcer at endoscopy in Ile-Ife, Nigeria.

BACKGROUND: Duodenal ulcer is the most common peptic ulcer disease worldwide. In the past, sub-Saharan Africa has been described as an area of mixed prevalence for peptic ulcer disease, but recent reports have disputed this. Changes in the prevalence of duodenal ulcer have been reported, with various reasons given for these. OBJECTIVE: To describe the change in endoscopic prevalence of duodenal ulcer at Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Nigeria, between January 2000 and December 2010. METHODS: This was a retrospective, descriptive study of patients who underwent upper gastrointestinal endoscopy in the endoscopy unit of OAUTH between January 2000 and December 2010. The data were obtained from the endoscopy register, demographic indices, presenting symptoms and post-endoscopic diagnoses being retrieved for each patient. The study period was divided into the years 2000 - 2004 and 2005 - 2010, the frequencies of duodenal ulcer and other post-endoscopic diagnoses being compared between these two time periods to see whether there were changes. RESULTS: Over the study period, 292 patients (15.8%) were diagnosed with duodenal ulcer, second only to 471 patients (26.2%) with acute gastritis. The prevalence of duodenal ulcer for 2000 - 2004 was 22.9% (n=211 patients) compared with 9.2% (n=81) for 2005 - 2010 (p<0.001). CONCLUSION: There was a significant decline in the endoscopic prevalence of duodenal ulcer over the decade.

Declining prevalence of duodenal ulcer at endoscopy in Ile-Ife, Nigeria

Background. Duodenal ulcer is the most common peptic ulcer disease worldwide. In the past, sub-Saharan Africa has been described as an area of mixed prevalence for peptic ulcer disease, but recent reports have disputed this. Changes in the prevalence of duodenal ulcer have been reported, with various reasons given for these.Objective. To describe the change in endoscopic prevalence of duodenal ulcer at Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Nigeria, between January 2000 and December 2010.Methods. This was a retrospective, descriptive study of patients who underwent upper gastrointestinal endoscopy in the endoscopy unit of OAUTH between January 2000 and December 2010. The data were obtained from the endoscopy register, demographic indices, presenting symptoms and post-endoscopic diagnoses being retrieved for each patient. The study period was divided into the years 2000 - 2004 and 2005 - 2010, the frequencies of duodenal ulcer and other post-endoscopic diagnoses being compared between these two time periods to see whether there were changes.Results. Over the study period, 292 patients (15.8%) were diagnosed with duodenal ulcer, second only to 471 patients (26.2%) with acute gastritis. The prevalence of duodenal ulcer for 2000 - 2004 was 22.9% (n=211 patients) compared with 9.2% (n=81) for 2005 - 2010 (p<0.001).Conclusion. There was a significant decline in the endoscopic prevalence of duodenal ulcer over the decade

Prevalence and Correlates of Peripheral Arterial Disease in Nigerians with Type 2 Diabetes.

Background. Peripheral arterial disease (PAD) is a major risk factor for nonhealing foot ulcers in people with diabetes. A number of traditional risk factors have been reported to be associated with PAD; however, there may be a need to consider nontraditional risk factors especially in some vulnerable populations. This study determined the prevalence and risk factors associated with PAD in diabetics. Methods. One hundred and fifty type 2 diabetics and an equal number of age- and sex-matched apparently healthy controls were studied. Assessment of PAD was made using history, palpation of lower limb vessels, and measurement of ankle-brachial index (ABI). Statistically significant differences between categorical and continuous variables were determined using Chi square (χ2) and Student t-tests, respectively. Regression analysis was done to determine the associated risk factors for PAD. Results. Prevalence of PAD using ABI was 22.0% and 8.0% among diabetic and nondiabetic populations, respectively. Peripheral arterial disease was associated with age, male gender, waist circumference, and high-sensitivity C-reactive protein. Conclusion. This study highlights the high prevalence of PAD in people with type 2 diabetes mellitus and in apparently healthy controls; age, male gender, abdominal obesity, and high hs-CRP values were the associated risk factors.

Comparison of lispro insulin and regular insulin in the management of hyperglycaemic emergencies.

This study compared the efficacy and safety of Lispro insulin and regular insulin in the management of hyperglycemic emergencies (HE). Fifty patients who presented in HE to the Emergency unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife participated in the study. Hyperglycaemic emergency was diagnosed when plasma glucose level was >17 mmol/L (300 mg/dl) in the presence of polyuria and polydipsia that warrants emergency hospital admission. Subjects in the Lispro insulin group had a statum dose of 0.3 IU/kg, while those in the regular insulin group had a statum dose of 20 IU equally split between the intravenous and intramuscular routes. Further insulin therapy was by the intramuscular route. Data was analysed using the Statistical package for social sciences (SPSS) version 11. Hyperglycaemia resolved within the first 8 hours in 60 and 40% percent of subjects in the lispro and regular insulin treated groups respectively. The time taken for resolution of hyperglycaemia was similar in both treatment groups, 6.6 +/- 0.8 hours for the lispro insulin group and 7.4 +/- 0.8 hours for the regular insulin group p = 0.51. The number of episodes of hypoglycaemia and hypokalemia in the two treatment groups did not differ statistically (p = 1.0 and 0.38 respectively). Eight (16%) subjects died. Lispro insulin is a safe and efficacious alternative to regular insulin in the treatment of HE.

Comparison of lispro insulin and regular insulin in the management of hyperglycaemic emergencies

This study compared the efficacy and safety of Lispro insulin and regular insulin in the management of hyperglycemic emergencies (HE). Fifty patients who presented in HE to the Emergency unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife participated in the study. Hyperglycaemic emergency was diagnosed when plasma glucose level was >17 mmol/L (300 mg/dl) in the presence of polyuria and polydipsia that warrants emergency hospital admission. Subjects in the Lispro insulin group had a statum dose of 0.3 IU/kg, while those in the regular insulin group had a statum dose of 20 IU equally split between the intravenous and intramuscular routes. Further insulin therapy was by the intramuscular route. Data was analysed using the Statistical package for social sciences (SPSS) version 11. Hyperglycaemia resolved within the first 8 hours in 60 and 40% percent of subjects in the lispro and regular insulin treated groups respectively. The time taken for resolution of hyperglycaemia was similar in both treatment groups, 6.6 +/- 0.8 hours for the lispro insulin group and 7.4 +/- 0.8 hours for the regular insulin group p = 0.51. The number of episodes of hypoglycaemia and hypokalemia in the two treatment groups did not differ statistically (p = 1.0 and 0.38 respectively). Eight (16%) subjects died. Lispro insulin is a safe and efficacious alternative to regular insulin in the treatment of HE