Ultrasound prevalence of gallstone disease in diabetic patients at Ibadan, Nigeria

Background: Gallstones (GS) in the gallbladder (GB) can be responsible for a whole spectrum of disease entities which may lead to a surgical emergency with high mortality. Diabetes mellitus (DM) is a debilitating disease that affects all systems in the body, and literature documents a higher incidence of gallstone disease (GSD) and its complicationsin diabetics than in the non-diabetic population. Most local studies on the association between GS formation and DM have focused on type 2 diabetics. This study was therefore designed to determine the prevalence of GS in both type 1 and type 2 DM and elucidate the demographic and social factors associated with formation of GS in diabetic patients.Materials and Methods: Four hundred diabetic patients aged between 15 and 82 years had abdominal ultrasound to diagnose or exclude the presence of GS.Results: GS was found in 70 (17.5%) of the 400 patients. Positive cases had a male to female ratio of 3:4 and 59 (51.92%) were above the age of 40 years with type 2 DM. Body mass index (BMI) greater than 25 kg/m2 was seen in 56 (48.3%) patients; smoking and alcohol intake were insignificantly implicated. Jaundice was recorded in 8 (11.4%) while abdominal pain was in 24 (34.3%) patients, and 52 (74.3%) patients of those with GSD had had diabetes for more than 4 years.Conclusion: GSD in DM is influenced significantly by age, BMI, and duration of the disease, while gender, social factors, and parity do not influence as strong associated factors.Key words: Diabetes mellitus, gallstones, ultrasoun

Interrelationship among physical activity, quality of life, clinical and sociodemographic characteristics in a sample of Nigerian patients with type 2 diabetes

A number of complexities surround the health and well-being of patients with type 2 diabetes. These difficulties relate to self-care efforts and outcomes, and several other factors play regulatory functions. This study was carried out to investigate the inter-relationship among physical activity, quality of life, and clinical and sociodemographic factors in a group of Nigerian patients with type 2 diabetes. The study was conducted at the outpatient clinics of two major healthcare facilities in Ibadan, Southwest Nigeria. Physical activity was assessed using the International Physical Activity Questionnaire, and quality of life was assessed using the Diabetes Quality of Life Brief Clinical Inventory. Clinical and sociodemographic characteristics were also documented. A total of 227 patients with type 2 diabetes with a mean age of 55.83 ± 13.76 years took part in the study. A total of 156 (68.7%) of the participants, had low level of physical activity, while 81 (35.7%) reported quality of life scores below the intermediate score and hypertension was the mo 63 (27.8%) of the participants. Being 50 years and older (OR = 2.5; 95% CI = 1.21-3.67) increased the odds of having lower quality of life, while physical activity of moderate-to-high intensity reduced the odds (OR = 0.4; 95% CI = 0.2-0.8). A substantial proportion of patients with type 2 diabetes had below intermediate level quality of life, and most of them were physically inactive. Lower quality of life was also linked with sociodemographic and clinical variables but patients with moderate-to-high physical activity were likely to reduce by half the risk of poor quality of life.Keywords: physical activity, quality of life, sociodemographic characteristic

Stepping Up Physical Exercise Among Nigerian Patients With Type 2 Diabetes: The Impact Of A Domesticated Type 2 Diabetes-Oriented Exercise Education Curriculum

Background: Most diabetes patients in Nigeria either do not exercise at all or do not exercise appropriately and this is thought to be due partly to an inadequate exercise education.Objectives: To investigate the impact of a type 2 diabetes-oriented exercise education curriculum (T2DEEC) on exercise performance and adiposity of type 2 diabetes patients.Materials and Methods: The patients (n=86) were randomized into either the T2DEEC or the control groups. The T2DEEC was administered to patients in the T2DEEC group while the controls were encouraged to exercise but did not go through the T2DEEC. The participants continued exercises at home for 12 weeks. Outcomes were amount of time and days spent on each of aerobic, resistance, joint mobilization and foot care exercises per week; waist circumference, body mass index, and percent body fat.Results: By the 12th week, the T2DEEC participants increased their exercise days from 1.2 to 3.8 days and increased aerobic, resistance, joint mobilization and foot care exercise times by 56.5, 42.3, 39.8 and 28.1 minutes respectively (p<0.05). The controls only increased their aerobic exercise time by 5.1 minutes (p=0.141) and maintained zero exercise times for resistance, joint mobilization and foot care exercises. Also the T2DEEC group but not the controls recorded significant improvements (p<0.05) in adiposity variables.Conclusions: The participants who were taught with the T2DEEC unlike those who received verbal encouragement to exercise improved their exercise performance and adiposity parameters significantly. The T2DEEC is recommended for exercise education of type 2 diabetes patients.Keywords: Type 2 diabetes, exercise education, joint mobilization, aerobic activities, curriculu

Effects of ginger (Zingiber officinale) on cadmium toxicity

Thirty six Winstar rats were divided into six equal groups and investigated for induced cadmium toxicity, and the detoxicating action of ginger on liver-accumulated cadmium. Group 1, the control, werefed with normal rat chow and water for six weeks. Group 2 were fed with normal rat chow and cadmium water (200 ppm Cd in water). Group 3 were fed with rat chow-ginger concentrate (95:5, w/w ratio) andwater, while Group 4 were fed with rat chow-ginger concentrate and cadmium water, all for six weeks. Group 5 were fed with normal rat chow and cadmium water initially for one week, followed by rat chowgingerconcentrate and water for five weeks; while Group 6 were fed with rat chow-ginger concentrate for one week, followed by normal rat chow and cadmium water for five weeks. Cadmium accumulated highly in rat livers without ginger administration, and raised serum glutamate oxaloacetatetransaminase (GOT) and glutamate pyruvate transaminase (GPT), while ginger lowered these parameters. Ginger had better therapeutic than prophylactic detoxication effects on liver cadmium accumulation, especially as further cadmium intake was stopped. It was concluded that cadmium detoxication by ginger was more effective therapeutically, than prophylactically, as further cadmium intake was avoided

Prevalence of obesity and ethno-geographic variation in body sizes of Nigerians with type 2 diabetes mellitus - a multi-centre study

BACKGROUND: Excess weight gain is common in people with type 2 diabetes mellitus (DM) but little is known about its ethno-geographic variation among the Nigerian populace. We aimed to report the prevalence and regional variation of overweight/obesity among subjects with type 2 DM in all the six geo-political regions of Nigeria.METHOD: Basic demographic and anthropometric data were consecutively collected from patients with type 2 DM attending out-patient clinics of seven designated teaching hospitals in the six geographic regions of the country using a pre-agreed method of measurement of anthropometry including waist circumference. The study was hospital-based descriptive cross-sectional in design. Body Mass Index (BMI) was categorised using the WHO criteria. Based on recommendations of the International Diabetes Federation (IDF) cut-off values for waist circumference, values >94 cm and > 80 cm were taken as abnormal for men and women respectively.RESULTS: A total of 709 subjects with DM comprising 378 (53.3%) females and 331 (46.7%) males (female: male ratio 1:1.14) with an overall mean age (SD) of 51.9 (13.9) years were evaluated. The prevalence of excess body weight among Nigerian subjects with type 2 DM was: peripheral (417 or 58.8%) and abdominal obesity (449 or 63.3%). Also, there was a significant wide variation in excess weight gain (both peripheral and central) across ethno-geographic regions (p=0.001) and between both sexes (p=0.001). In both peripheral and abdominal obesities, whether intra or inter centres, the female subjects with type 2 DM demonstrated relatively higher proportions of anthropometric measures. Generally, subjects from south-south and south-east Nigeria had higher BMI and abdominal obesity compared to those from south-west who had the lowest. The female subjects with type 2 DM were heavier peripherally and centrally compared to their male counterparts.CONCLUSION: The prevalence of peripheral and central obesity among Nigerians living with type 2 DM (especially the female subjects) is unacceptably high. Additionally, there is a wide variation in the proportion and absolute values of both peripheral and central obesity across different parts of Nigeria.KEY WORDS: Obesity, Prevalence, Ethno-Geographic Variation, Nigerians, Type 2 Diabetes Mellitu

Strategies for preventing of hyperglycaemic emergencies in Nigeria

The mortality and morbidity of acute metabolic complications of diabetes, particularly DKA and HHS are unacceptably high in Nigeria. Prevention of occurrence of these hyperglycaemic emergencies (HE) is the only rational way for a resource poor country like Nigeria. Prevention requires careful identification of precipitating factors of HE. The leading precipitating factors of HE in Nigeria are infections, inadequate or inappropriate use of anti-diabetic agents, especially insulin. HE may also be the first presentation in persons previously unknown to have diabetes. Measures to prevent HE include creationof awareness in the public, effective and systematic education of the persons living with diabetes and capacity building and manpower development of the healthcare personnel. There should be critical appraisal of our healthcare system with a view to restructuring so it can be more accessible to patients and can deliver quality diabetes care. Finally government must sincerely provide an alternative of healthcare financing for the citizens, especially those living with chronic medical conditions like diabetes

Anthropometric characteristics of offspring of Nigerian Type 2 Diabetics

Objectives: Type 2 diabetes mellitus (DM) has a strong genetic component. Overall obesity and central obesity have strong associations with insulin resistance, which is a major factor in the development of impaired glucose tolerance (IGT) and Type 2 DM. The impact of a parental history of Type 2DM on anthropometric measurements known to govern glucose tolerance was examined in this study. Materials and Methods: Weight, height, body mass index, waist circumference, hip circumference and waist-hip ratio were measured in 52 offspring of Nigerian Type 2 diabetic patients and compared with 50 control subjects who had a similar distribution of age, sex and socio-economic class. Results: Offspring of diabetics had a significantly higher mean (SD) (i) weight (69.9(15.1)kg vs 63.8 (63.8(112)kg;p=0.024); (ii) body mass index (25.0(4.9)kg/m2 vs 23.0 (3.0)kg/m2;p=0.013;) (iii) Waist circumference (82.3(12.2) cm vs 77.2 (8.3) cm; P=0.014); (iv) hip circumference (99.0 (11.4) cm vs. 93.0 (7.2) cm; p=0.005). The waist-hip ration for both groups of subjects did not differ significantly (0.83(0.06) versus 0.82 (0.05);p=0.52). Conclusion: These results suggest that a parental history of Type 2 DM influences body fat and its distribution resulting in greater degrees of generalized and central/abdominal fat, implying a greater risk of developing Type 2 DM in view of the relationship between body fat distribution and insulin resistance. Long-term prospective studies are needed to define anthropometric indices predictive of the development of Type 2 DM, as well as its relation to insulin sensitivity, amongst Nigerians. KEY WORDS:- Type 2 diabetic parents, offspring, Anthropometry Nigerian Journal of Clinical Practice Vol.5(2) 2002: 75-8

Process and outcome measures of quality of care at the diabetes outpatient clinic, University College Hospital, Ibadan

Objective: The study aims to assess the quality of care provided at a diabetes outpatient clinic of a tertiary hospital in Nigeria using quality indicators approved by the National Diabetes Quality Improvement Alliance (NDQIA).Materials and Methods: The medical records of patients who had visited the clinic at least two times within a 12 months period preceding the index visit were reviewed during a 5 month period. Process measure indicators, approved by the NDQIA (evaluating the functioning of the clinic) and outcome measures, published by the American Diabetes Association, (evaluating the health status of the attending patients) were retrieved from the medical records.Results: The 332 records reviewed showed that the most consistently performed process measures were blood pressure and weight measurement (>90%). Foot examination was done infrequently (10.5%). Less than 50% had at least an annual low‑density lipoprotein cholesterol (LDL‑C) and hemoglobin A1c testing done. The mean (standard deviation) HbA1C (%), LDL‑C (mg/dL) systolic blood pressure (SBP) (mmHg), and diastolic blood pressure (DBP) (mmHg) were 7.6 (2.0), 107.3 (31.5), 134.3 (20.8), 79.5 (11.0), respectively. HbA1C >8.0%, LDL‑C >130 mg/dL, SBP >130 mmHg, and DBP >90 mmHg) were observed in 34.8%, 21.1%, 40.4%, and 23.8%, respectively.Conclusion: Although the organization of the outpatient services allowed for good performance with regards to “free” services such as blood pressure and weight measurement, it performed suboptimally for foot examinations. Performance indicators that required payment were consistently underperformed. Regular assessment of the quality of care may help in the identification of opportunities for improvement in the organization and delivery of care.Key words: Diabetes, outpatient, qualit