The burden of diabetic complications in subjects with type 2 diabetes attending the diabetes clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria - a cross-sectional study.

Introduction: the increasing prevalence of diabetes (DM) worldwide has resulted in an increase in the morbidity and mortality of DM. This burden is as a result of the development of the chronic complications associated with it. This study determined the burden of occurrence of microvascular and macrovascular complications of subjects with type 2 diabetes attending the out -patient clinic of a tertiary hospital in south west Nigeria. Methods: this cross-sectional study involved 400 consecutive subjects with type 2 diabetes. A study proforma was used to document the socio demographic data. While clinical assessment for anthropometric measurement, blood pressure was done. Laboratory measurement of blood glucose control and lipids were done. Assessment of the occurrence of microvascular and macrovascular complications were performed and documented. Results: four hundred type 2 DM participants made up of 190 males and 210 females with a mean age of 60.35±9.53 years, with a mean age of 60.35(SD 9.53) years for males and 60.81(SD10.29) years for females. Median duration of DM for all subjects was 6.00(IQR 3.00 - 11.00) years. Majority (45%) of the participants were overweight. The prevalence of hypertension was 78% and poor glycaemia using HBA1C was 75.5% and 59.8% had dyslipidaemia. The occurrence of microvascular complications (diabetic neuropathy - 82%, diabetic retinopathy - 46% and diabetic nephropathy - 44%) 69.3% while macrovascular complications (peripheral arterial disease - 42.5%, stroke - 4%, electrocardiographic changes if ischaemic heart disease -9.3% and left ventricular hypertrophy - 22%) in 49%. Regression analyses showed advancing age aOR (1.18 [95%CI 1.01 - 1.38]) and waist circumference (aOR 1.17 [95% CI 1.00 - 1.36]), as significant contributors to the presence of diabetes complications. Conclusion: the risk factors of both microvascular and macrovascular complications remain high in our clinic and this is linked to the high burden of diabetes mellitus and its long duration.

Diabetes and peripheral artery disease: A review.

Peripheral arterial disease (PAD) refers to partial or complete occlusion of the peripheral vessels of the upper and lower limbs. It usually occurs as part of systemic atherosclerosis in the coronary and cerebral arteries. The prevalence of PAD is expected to continue to increase in the foreseeable future owing to the rise in the occurrence of its major risk factors. Nonhealing ulcers, limb amputation and physical disability are some of its major complications. Diabetes mellitus (DM) remains a major risk for PAD, with DM patients having more than two-fold increased prevalence of PAD compared with the general population. The clinical presentation in people with DM also differs slightly from that in the general population. In addition, PAD in DM may lead to diabetic foot ulcers (DFUs), which precipitate hyperglycaemic emergencies and result in increased hospital admissions, reduced quality of life, and mortality. Despite the epidemiological and clinical importance of PAD, it remains largely under diagnosed and hence undertreated, possibly because it is largely asymptomatic. Emphasis has been placed on neuropathy as a cause of DFUs, however PAD is equally important. This review examines the epidemiology, pathophysiology and diagnosis of lower limb PAD in people with diabetes and relates these to the general population. It also highlights recent innovations in the management of PAD.

The Relationship Between Glycaemic Control and Non-Alcoholic Fatty Liver Disease in Nigerian Type 2 Diabetic Patients.

BACKGROUND: Metabolic risk factors associated with non-alcoholic fatty liver disease (NAFLD) include Type 2 diabetes mellitus (T2DM), obesity and dyslipidaemia. Prevention or management of these risk factors with glycaemic control, weight reduction and low serum lipid levels respectively have been reported to reduce the risk of NAFLD or slow its progression. Since ultrasound (USS) is a safe and reliable method of identifying fatty changes in the liver, this study was done to determine the relationship between glycaemic control and ultrasound diagnosed NAFLD in T2DM. METHODOLOGY: Demographic data, anthropometric measurements and laboratory tests including glycated haemoglobin (HbA1c), fasting blood glucose (FBG) and serum lipids of 80 T2DM subjects aged 40-80 years were taken. Their livers were evaluated using B-mode ultrasound, and the data obtained were statistically analysed using SPSS version 20. RESULTS: Fifty-five of all participants (68.8%) were diagnosed with NAFLD sonographic grades 1, 2 and 3 made up of 13 (16.3%), 26 (32.5%) and 16 (20.0%), respectively while 25 (37.2%) had grade 0. The prevalence of NAFLD in T2DM varied significantly with BMI (p = 0.001) and glycaemic control (p = 0.048) while the USS grades of NAFLD varied significantly with age (p = 0.043) and BMI (p = 0.006). The independent strong predictors of NAFLD were overweight (r = 0.409, p = 0.012, OR = 6.626) and obesity (r = 0.411 p = 0.009, OR = 11.508), while poor glycaemic control (r = 0.270, p = 0.015, OR = 3.473) was a moderate independent predictor. CONCLUSION: The prevalence of NAFLD increases with increasing BMI and HBA1c in T2DM, while its ultrasound grade varies with BMI. Overweight, obesity and poor glycaemic control are independent predictors of NAFLD.