Optimizing Type 2 Diabetes Management in a Medically Complex Patient: A Case Report of a Patient with Type 2 Diabetes and HIV

Jean Damascene Kabakambira,1 Jason M Kong2 1Department of Medicine, University of Rwanda, Kigali, Rwanda; 2Division of Endocrinology, University of British Columbia, Vancouver, BC, CanadaCorrespondence: Jean Damascene Kabakambira, Department of Medicine, University of Rwanda, KN 4th Avenue, P.O Box 655, Kigali, Rwanda, Tel +250788800966, Email [email protected]: The prevalence of diabetes is rapidly escalating, with projections indicating that 783 million individuals aged 20– 79 years worldwide will be affected by diabetes. This rise is concurrent with a persistent prevalence of HIV in developing nations, while conventional risk factors such as sedentary lifestyle and unhealthy diet may account for this trend, HIV and its treatment have emerged as potential contributing factors. Achieving optimal diabetes control in patients with HIV necessitates a profound understanding of the intricate interplay between the two diseases and their respective treatments.Case Report: We present a case involving a patient with long standing type 2 diabetes, coexisting HIV infection and hypertension. Despite receiving high doses of insulin, as advised by most diabetes guidelines, the patient’s diabetes remained poorly controlled. In lieu of strictly adhering to guidelines, our primary focus was to conduct a comprehensive reevaluation of the patient’s medications, prioritizing the development of streamlined and safe treatment regimens for all three of her medical conditions. Employing this strategy, we observed swift improvement in blood glucose levels, leading to successful diabetes control within one year.Conclusion: This case underscores the importance of individualizing diabetes management in patients with multiple comorbidities. It highlights the significance of reassessing treatment approaches beyond standard guidelines, with a focus on tailoring therapy to suit the unique needs and complexities of each patient’s medical profile. Such personalized interventions hold promise for achieving optimal diabetes control in individuals with diverse comorbidities.Keywords: diabetes, HIV, case report, Rwand

The Role of the Integrated District Hospital Based Non Communicable Diseases’ Clinics in Cardiovascular Disease Control: Preliminary Data from Rwanda

Jean Damascene Kabakambira,1,2 Patrick Shumbusho,1,2 Gisele Mujawamariya,1 William Rutagengwa,3 Marc Twagirumukiza2,4 1Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda; 2College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; 3Department of Internal Medicine, Nyamata District Hospital, Bugesera, Rwanda; 4Faculty of Medicine and Health Sciences, Ghent University, Ghent, BelgiumCorrespondence: Jean Damascene Kabakambira, Department of Internal Medicine, University Teaching Hospital of Kigali, KN 4th Avenue, P.O Box 655, Kigali, Rwanda, Tel +250 788800966, Email [email protected]: Noncommunicable diseases (NCDs), remain the leading cause of death worldwide and represent an emerging global health threat. In Rwanda and elsewhere, the prevalence of cardiovascular diseases is increasing. To address this global health threat, Rwanda launched integrated nurse-led NCD clinics in all the forty-five District Hospitals across the country in 2006, but no evaluation study has been conducted so far for the added value of this program. The main goal of this study was to assess the impact of NCD clinics on disease control in Rwanda.Methods: This was a retrospective ambulatory patient chart review at a rural district hospital and an urban teaching hospital; which enrolled patients with diabetes and/or hypertension who consulted in a period of 1 month with retrospective data of one year.Results: A total of 199 patients’ electronic health records were reviewed from the University Teaching Hospital of Kigali (CHUK) (53%) and Nyamata District Hospital (47%). Among them, 31% had diabetes, 38% had hypertension and 31% had both diseases. The mean age for the total cohort was 60 years and was predominantly female at 70%. Throughout the year, about 59% patients with hypertension had blood pressure control at the district hospital as opposed to 38% at the referral hospital. The rate of diabetes control was 20% at the referral hospital, but no comparison could be established between the two health facilities as the follow up laboratory markers were not available at the district hospital.Conclusion: There was a consistent blood pressure control at the district hospital. Diabetes control was not optimal at the referral hospital despite the presence of human resources and logistics required for diabetes care. The situation was even worse at the district hospital where the follow up markers were rarely available.Keywords: NCD clinic, diabetes, hypertension, Rwand