Serum C-Reactive Protein in Nigerians With Type 2 Diabetes Mellitus

Background: C-reactive protein is an acute-phase proteins, produce in the liver, its release is stimulated by cytokines (interleukin 6 and tumour necrosis factor alpha). Elevated level of it is a risk factor for coronary heart disease. Baseline levels of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. Diabetics are at increased risk for coronary heart disease, data from the Framingham Study showed a two-to three-fold elevation in the risk of clinically evident atherosclerotic disease in patients with type II diabetes compared to those without diabetes. However, but data regarding CRP in Nigerian diabetic is lacking.Method: A cross-sectional study conducted among patients attending out patient clinic of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Measurement of C-reactive protein was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA).Results: A total of 125 consecutive subjects were recruited comprising 75 patients with type II diabetes mellitus with or without hypertension and 50 apparently healthy age-and-sex comparable controls. There was a significant difference between the mean systolic and diastolic blood pressures of the patients and controls. The fasting blood glucose and C-reactive protein were significantly higher in diabetics compared to controls. There was a positive and significant correlation between FBG and CRP in both patients and controls. Conclusion: This study showed that diabetics have significantly higher serum C-reactive protein compared to the apparently controls. Also there was a positive and significant correlation between C-reactive protein and fasting blood glucose among both patients and controls

Seroprevalence of Hepatitis C Virus Infection in Nigerians with Type 2 Diabetes Mellitus

Background: Several studies have suggested a strong epidemiologic association between Diabetes Mellitus (DM) and Hepatitis C Virus (HCV) infection in some populations. However, the reasons why chronic HCV infection is prevalent in DM remain unknown. Our aims were to determine the prevalence of HCV infection in a population of Nigerian diabetics compared with the general population as well as assess the influence of sex and age on HCV infection in the same diabetic population. Design and Methods: A total of 115 diabetic patients were compared with 2,301 blood donors matched by recognized risk factors to acquire HCV infection. Serologic testing for anti HCV was done using a commercial enzyme-linked immunosorbent assay (ELISA) kits. Results: Sixty (60) type 2 diabetic patients were males while fifty-five (55) were females. Their mean age was 55.4 ± 9 years and mean blood glucose level was 8.5mmol/l. One subject tested positive for HCV infection. The control group consisted of 2,031 adults recruited from the blood donor\'s clinic. Forty five of them (2.2%) tested positive for HCV. Conclusion: Our preliminary results suggest a low sero-prevalence of HCV infection among our patients with type 2 diabetes. Presently, routine screening for HCV infection in persons with diabetes may not be necessary. Keywords: HCV infection, type 2 diabetes mellitus Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 199-20

Burden of Diabetes Mellitus

Editorial articl

Assessment of Limited Joint Mobility of the Hand in Black Africans with Diabetes Mellitus and in Non-diabetics

ABSTRACT Objective: This study is designed to further characterize Limited Joint Mobility (LJM) of the hand using quantitative goniometric measurements among Black Africans with Type 2 diabetes mellitus and nondiabetes. Methods: Seventy-six patients with Type 2 diabetes and 63 normal controls matched for age and gender were purposively selected. Visual clinical examination and quantitative goniometric assessment of patients with DM and non-DM controls were done. The LJM was graded using the criteria of Silverstein et al. Glycaemic control and proteinuria were also assessed. Results: Prevalence of LJM among Type 2 DM patients was 26.3% compared with 4.8% in normal controls. Subjects with LJM within the control group were significantly older than those with LJM within the DM group (p < 0.05). Prayer sign was 11.8% in DM patients compared with 4.8% of control. The flattening sign demonstrated by the inability to flatten their hands on a flat surface was more in patients with DM (10.5%) compared with 4.8% in the control group. Stage II LJM with 18.4% prevalence was the commonest followed by Stage III (7.9%) among patients with DM. Poor glycaemic control was found in 85%, using fasting plasma glucose and 70%, using 2-hour postprandial blood glucose (2 hpp). Conclusion: We conclude that Black Africans with Type 2 DM only have moderately severe cases of LJM. Evaluación de la Limitación de la Movilidad Articular de la Mano en Africanos Negros que Padecen de Diabetes Mellitus y en los no Diabéticos RESUMEN Objetivo: Este estudio fue diseñado para caracterizar más a fondo la limitación de la movilidad articular (LMA) de la mano, usando mediciones goniométricas entre africanos. Métodos: Setenta y seis pacientes con diabetes mellitus tipo 2 y 63 controles normales pareados por edad y género fueron seleccionados para este propósito. Se realizó un examen clínico visual y una evaluación goniométrica cuantitativa de los pacientes con DM y controles no DM. La LMA fue graduada usando los criterios de Silverstein et al. También se evaluaron el control glicérico y la proteinuria. Resultados: La prevalencia de LMA entre pacientes con DM tipo 2 fue de 26.3% comparada con 4.8% en los controles normales. Los sujetos con LMA en el grupo de control fueron significativamente mayores en edad que aquellos con LMA en el grupo con DM (p < 0.05). La signo de las manos en oración fue 11.8% en los pacientes con DM comparado con el 4.8% del control. El signo de aplanamiento demostrado por la incapacidad de los pacientes de poner sus manos totalmente planas sobreuna superficie, fue mayor en aquellos con DM (10.5%) en comparación con el 4.8% del grupo control. La LMA de la segunda etapa con una prevalencia de 18.4%, fue la más común seguida por la de etapa III (7.9%) entre pacientes con DM. Un control glicémico pobre fue hallado en 85%, usando glucosa plasmática en ayunas. Conclusión: Concluimos que los africanos negros con DM tipo 2 presentan sólo casos moderadamente severos de LM

A Comparison of two measures of quality of life of Nigerian clinic patients with type 2 Diabetes Mellitus

Background: We present data comparing the quality of life effects of type 2 diabetes determined by the Bradley well-being questionnaire and the WHOQOL-BREF, a generic instrument. We also present data on the reliability and validity of these instruments. Method: The Well-being and the WHO- bref were administered on fifty-three consecutive type 2 diabetics. The internal consistency of the quality of life scales was assessed using Cronbach&apos;s alpha. Convergent, discriminant, and known groups validity were determined and compared. Results: Our patients had a mean age of 55.8±13 years. 31(58.5%) were males and all patients had been diabetic for 7.9±7.1 years. 13(24.5%) were being treated with oral agents, 14(26.4%) were on insulin and 26(49.1%) were on combined therapy. The Cronbach alpha coefficients ranged from 0.31 to 0.72 on the Well-being subscales and from 0.47 to 0.78 on the WHOQOL-BREF subscales. Both scales were modestly related to one another. In general the quality of life measures were not influenced by characteristics such as age, gender, marital or educational status. Both scales were not influenced significantly by treatment type or the severity or number of complications. Conclusion: Our study has shown how two different measures of quality of life perform in patients with type 2 diabetes. Even though the subscales of the Well-being and WHOQOL-BREF were not very sensitive to external criteria of disease impact (complications) casting a doubt on their utility as psychological outcome measures, they demonstrated fairly reasonable internal consistency in our patients with type 2 diabetes. Further larger studies are thus required to clarify this given our present limitations

A Descriptive Study Of Foot Complications In Diabetic Patients With Symptomatic Peripheral Neuropathy

Background Symptomatic peripheral neuropathy in a diabetic patient may be associated with the presence of other foot complications, which may otherwise be overlooked. Objective We conducted this study to determine the prevalence of symptomatic peripheral neuropathy among diabetic patients attending the diabetes outpatient clinic of our hospital as well as document the presence of other foot complications/problems in patients with symptomatic peripheral neuropathy. Methods A cross-sectional survey of foot complications was conducted over a 6-month period in diabetic patients symptomatic for peripheral neuropathy and compared with age/sex matched diabetics without peripheral neuropathy and apparently healthy individuals. Results Of 322 diabetic patients studied, 64(19%) had symptomatic peripheral neuropathy. The most frequent symptoms of peripheral neuropathy were numbness or tingling sensation in (65.6%), cramps, aches and fatigue (14.1%) respectively, and burning sensation (10.9%). Dry skin, hyperpigmentation, corns and callosities, cracked skin and fungal infections were the most frequent lesions seen in diabetic patients symptomatic for peripheral neuropathy. These lesions occurred more frequently in them than in patients without neuropathy and healthy subjects. While (34.7%) symptomatic patients had foot ulcers, none was recorded in the asymptomatic or healthy population. Conclusion Foot complications other than foot ulcers may occur in diabetic patients with symptomatic peripheral neuropathy. Awareness of these skin and foot lesions and their sequelae with prompt initiation of measures to limit disability may prevent limb losses/foot deformities and should be emphasised. Proper education on foot care and frequent limb inspection can never be over emphasised. Moreover, these foot lesions may also serve as markers for the presence as well as severity of peripheral neuropathy. Introduction Les neuropathies diabétiques symptomatiques s\'accompagnent de complications au niveau des pieds qui risquent d\'être négligées. But Le but de l\'étude est de déterminer la prévalence des neuropathies périphériques ainsi que les complications au niveau des pieds chez des diabétiques suivis dans notre département, en ambulatoire. Méthode Une étude transversale a été menée pendant six mois chez des diabétiques atteints d\'une neuropathie périphérique symptomatique et des individus apparemment sains. Résultats Sur les 322 patients étudiés, 64 (19%) présentaient une neuropathie périphérique symptomatique. Les symptômes les plus souvent rencontrés sont : les engourdissements ou picotements (65,6%), les crampes, des douleurs continues, une fatigabilité (14,1%) et une impression de brûlure (10,9%). Une peau sèche et craquelée, une hyperpigmentation, des callosities ainsi que des signes de mycoses étaient les lésions les plus souvent observées chez les patients diabétiques ayant une neuropathie périphérique. Aucun ulcère n\'a été noté chez les individus sains contrairement à la population diabétique ( 34,7%). Conclusion L\'attention est portée sur la nécessité de surveiller et de diagnostiquer au plus tôt les lésions cutanées chez les patients diabétiques. Par ailleurs, les lésions cutanées sont l\'expression de la sévérité de la neuropathie périphérique sous-jacente, chez ce type de patients. Keywords: Diabetes mellitus, foot complications, peripheral neuropathy, Afrique, diabete, complications, neuropathie peripherique, pied diabetique African Journal of Neurological Sciences Vol. 24 (1) 2005: pp. 7-1

Asymptomatic bacteriuria in patients with diabetes mellitus in Ile-Iffe, South-West Nigeria

No Abstract. East African Medical Journal Vol. 85 (1) 2008 pp. 18-2

Relationship between C-Reactive Protein and Body Mass Index in Nigerians with Type II Diabetes Mellitus

Background. C-reactive protein is an acute-phase protein synthesized in the liver and its release is stimulated by cytokines (interleukin 6 and tumour necrosis factor alpha). Baseline levels of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. In older men and women, elevated level CRP was found to be associated with a 10-year risk of coronary heart diseaseregardless of the presence or absence of cardiac risk factors. Studies have shown a significant correlation between CRP and body mass index (BMI). But data regarding CRP and BMI in our Nigerian population is lacking hence the decision to conduct this study.Method. The study design was cross-sectional comprising 125 consecutive subjects consisting of 75 patients with type II diabetes mellitus with or without hypertension attending medical outpatient clinic of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State (in southwestern Nigeria), and 50 apparently healthy age- and sex-comparable controls from the hospital staff and patient relatives who were themselves not relatives of the study patients were recruited. Measurement of C-reactive protein was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA).Results. Body mass index differed significantly between patients and controls as well as the C-reactive protein level. There was a positiveand significant correlation between serum CRP and body mass index among both patients and controls.Conclusion. C-reactive protein was found to be significantly higher in diabetics compared to controls. In addition, there was a positive andsignificant correlation between body mass index and C-reactive protein even after adjusting for hyperglycaemia.Key words: C-Reactive Protein, Body Mass Index, Type II diabetes Mellitus

Left ventricular function in Nigerian diabetics with or without hypertension

Objectives: This study evaluated left ventricular function, using echocardiographic methods, in Nigerian diabetics with additional aim of assessing the effect of coexisting hypertension. Design: A descriptive cross sectional studySetting: Hospital based studySubjects: Ninety five subjects aged 30-60 years comprising 31 hypertensive diabetics, 30 normotensive diabetics, and 34 age- and sex- matched non diabetic non hypertensive subjects as control.Main Outcome measures: All subjects had transthoracic 2D/Mmode and Doppler flow echocardiography performed to determine left ventricular systolic and diastolic functions.Results: Age and sex of the subjects were comparable. Duration of diabetics for hypertensive diabetics and normotensive diabetics were 36.78 &plusmn;31.26 months and 36.12 &plusmn; 47.50 months respectively. Mean fasting blood glucose was significantly higher in the normotensive diabetics (8.94 &plusmn; 2.13 mmol/L) than hypertensive diabetics (6.04 &plusmn; 2.01 mmol/L); p=0.038. There was stepwise reduction in Left Ventricular Ejection Fraction(LVEF) from normal controls (71.77 &plusmn; 8.26 %) to normotensive diabetics (65.34 &plusmn; 9.75 %) and hypertensive diabetics (64.29 &plusmn;10.99 %); p= 0.005. The diabetic subjects had impaired LV diastolic function, as shown by their significantly longer Isovolumic relaxation time (IVRT) and deceleration time and lower transmitral E: A ratio compared with controls. No statistically significant difference existed in these indices of LV diastolic function between the normotensive and hypertensive diabetics, thoughhypertensive diabetics had higher LVMI than the normotensive diabetics.Conclusion: Left ventricular function is impaired in diabetics. This may be independent of coexisting hypertension, though presence of hypertension appears to worsen it.Key words: diabetes, echocardiography, left ventricular function