Diabetes Care in Nigeria

Background: Diabetes is a noncommunicable disease that has attained great significance in the sub-Saharan region, with Nigeria being the most affected. Many persons with the condition suffer a reduced life expectancy and quality of life. Diabetes places an extra burden on the individuals and families affected, especially for the majority of patients unable to access quality health care. Objective: To describe the elements of diabetes management in Nigeria, areas for improvement, and proposed strategies to optimize care. Methods: A systematic literature search was performed on diabetes in Nigeria. Local and nonindexed literature, PubMed, and Google Scholar were used to source information on the subject. Findings: Diabetes-related morbidity and mortality continue to increase due to population expansion, urban migration, declining physical activity, and dietary factors. The organization of diabetes care is poorly coordinated, especially at the primary and secondary tiers of the public health care system, with consequent poor outcomes. Thus life expectancy (just about 50 years), which is low in the region, is further reduced by the double jeopardy of communicable (eg, tuberculosis, HIV/AIDS, and malaria) and noncommunicable diseases, such as diabetes and its closely related comorbidity, hypertension. Conclusions: The way forward is to improve maternal and child care, promote screening of at-risk populations, and develop strategies for primary prevention and early intervention to optimize glycemic control. Greater commitment to health care by the government and nongovernmental organizations and greater awareness by Nigerians should facilitate the desired improvements in disease prevention and glycemic control in those who are already affected

Characterization of lipid parameters in diabetes mellitus – a Nigerian report

<p>Abstract</p> <p>Background</p> <p>Diabetes mellitus (DM) is a disorder that is often associated with cardiovascular events and underlying lipid abnormalities. Cardiovascular complications are common causes of DM deaths in Nigeria yet dyslipidaemia is one aspect of DM that is underdiagnosed and undertreated in our patients. This report seeks to determine the prevalence and pattern of lipid abnormalities in Nigerians with types I and 2 DM.</p> <p>Methods</p> <p>A total of 600 patients with DM aged between 22 – 79 years were evaluated for lipid abnormalities. The anthropometric indices, glycosylated haemoglobin, pattern of DM treatment and co-morbidities were noted. Total cholesterol (TCHOL), triglyceride (TG), high density lipoproteins (HDL-C), low density lipoproteins cholesterol (LDL-C) levels and the atherogenic indices levels were documented. Test statistic used included student's t test and χ².</p> <p>Results</p> <p>Well over half (89%) of the study subjects had lipid abnormalities and there was no statistically significant difference in the proportions of subjects with type 1 and 2 DM with lipid abnormalities. Elevated LDL-C, TCHOL, TG and reduced HDL-C were noted in 74%, 42%, 13%, and 53% respectively of the study subjects. The commonly noted combined lipid abnormalities were elevated TG and reduced HDL-C. Hypertension, significant histories of smoking and alcohol ingestion were found to be potential determinants of the occurrence of dyslipidaemia. Age, sex, type of DM and anthropometric indices were found to be determinants of the the pattern of dyslipidaemia. Only a small proportion – (8%)-of the subjects with dyslipidaemia were on treatment for it.</p> <p>Conclusion</p> <p>Having defined the scope of dyslipidaemia in our patients and also highlighting its gross undertreatment, we hope that our data will help sensitize health care practitioners on screening for and treating dyslipidaemia. Elevated LDL-C and reduced HDL-C should be the primary targets of treatment in our patients with dyslipidaemia.</p

Non alcoholic fatty liver disease in a Nigerian population with type II diabetes mellitus

Introduction: Worldwide, Non-alcoholic fatty liver disease (NAFLD) has become an important cause of chronic liver disease and cardiovascular morbidity, even more so in subjects with Type II Diabetes Mellitus (T2DM). The aim of this study was to determine the prevalence and risk factors of NAFLD in an African population with Type II Diabetes Mellitus. Methods: We performed a case control study and evaluated anthropometric and biochemical risk factors for NAFLD in 336 subjects (T2DM and non-diabetic controls). Parameters assessed included estimation of BMI (Body Mass Index), measurement of waist circumference (WC), serum cholesterol including HDL-C, LDL-C and triglyceride and serum transaminases (ALT and AST). Hepatitis B and C viral antibody screening was also performed. The diagnosis of NAFLD was confirmed by identification of hepatic steatosis on abdominal ultrasound scan evaluation and exclusion of significant alcohol consumption. Results: NAFLD was identified in 16.7% (28 of 168) patients with T2DM compared with 1.2% (2 of 168) non-diabetic controls (Odds Ratio 16.6; p&lt;0.001). Central obesity (WC &gt; 102cm) and dyslipidaemia (HDL-c &lt; 40mg/dl) were independently associated with NAFLD in male subjects with T2DM (p=0.03 and p=0.04 respectively). Conclusion: NAFLD occurred more frequently in patients with T2DM than controls and was associated with central obesity and dyslipidaemia. The diabetic subjects with NAFLD will require more intensive therapy to decrease the risk of hepatic, cardiovascular and other adverse events.Pan African Medical Journal 2016; 2

Pattern of skin disorders in a rural community in Lagos State, Nigeria

Background: Skin disorders are commonly found in the community. In most circumstances, they are easily treatable and preventable. Social and environmental factors play a key role in the epidemiology of skin disease. It is important to assess the dermatological needs of a community as this will help address specific needs. The objective of this study was to identify the skin disorders in a rural community.Methods: This was a cross-sectional study carried out in Epeme, a rural community in Lagos state, South west Nigeria. All consenting adults and children with parental consent that presented for the screening programme were recruited. A self-reported questionnaire was administered by face-to face interview. Socio-demographic data were collected. All those with a skin disease or complaint were further questioned and a clinical examination carried out and findings recorded.Results: There were 263 individuals screened; 156 adults and 107 children. Mean age of adults was 38.04 ± 13.04 years and children 9.50 ± 4.67 years. Thirty adults (19.2%) and 27 (25.2%) children had a skin disorder identified clinically. Among the adults the following categories of skin disorders were found: infection 12 (7.6%), disorders of sebaceous glands 5 (3.2%), pigmentary disorders 2 (1.2%) and pruritus 1 (0.6%). Among children, 21 (19.6%) had skin infections, 2 (1.8%) each with eczema and sebaceous gland disorder. Majority of the infections in children were of fungal aetiology.Conclusion: Infections still remain the major skin disorders in rural communities in Nigeria where dermatologic healthcare is not readily available and accessible.Keywords: pattern, skin disorders, skin infection, rural, community, Nigeri

Patterns of drug use among type 2 diabetic patients with comorbidities attending a tertiary centre in Lagos Nigeria

Introduction – Diabetes care involves the use of drugs to control hyperglycaemia and treatment of comorbid disorders in order to prevent cardiovascular morbidity and other complications. This study investigated patterns of comorbidities and drug use among diabetic patients at a tertiary centre in Lagos, Nigeria. Method – This was a cross-sectional study carried out among 216 patients with type 2 DM attending Diabetes Clinic of a tertiary centre. Data was captured by using a questionnaire which documented biodata, number of comorbidities, number and combination of drugs for each participant and analysed using SPSS version 18. Results – Comorbidities were present among 215 out of 216 (99.54%) participants and hypertension and dyslipidaemia were the most common comorbid disorders. The number of pills consumed per patient ranged from 1 to10 with a mean of 4.78± 1.73 and 57.4% were on 5 pills or more. Fixed-dose combination was used in 37 (17.1%) of the patients. Majority of the patients were on metformin as monotherapy or in combination therapy. Antihypertensive most prescribed were renin-angiotensin system (RAS) blockers which was prescribed in 73% of participants. Antiplatelet drugs were used for both primary and secondary prevention of CVDs. Statin was used in less than 50% of the population. Double RAS blockade was also observed in 6% of participants. Conclusions – Comorbidities were common in the diabetic population. Pill load was high but appropriate in most patients. Statin uptake was suboptimal while there was increased uptake of antiplatelet drugs among participants

Clinical features, predictive factors and outcome of hyperglycaemic emergencies in a developing country

<p>Abstract</p> <p>Background</p> <p>Hyperglycaemic emergencies are common acute complications of diabetes mellitus (DM) but unfortunately, there is a dearth of published data on this entity from Nigeria. This study attempts to describe the clinical and laboratory scenario associated with this complication of DM.</p> <p>Methods</p> <p>This study was carried out in DM patients who presented to an urban hospital in Nigeria with hyperglycaemic emergencies (HEs). The information extracted included biodata, laboratory data and hospitalization outcome. Outcome measures included mortality rates, case fatality rates and predictive factors for HEs mortality. Statistical tests used are <it>χ</it>², Student's t test and logistic regression.</p> <p>Results</p> <p>A total of 111 subjects with HEs were recruited for the study. Diabetes ketoacidosis (DKA) and hyperosomolar hyperglycaemic state (HHS) accounted for 94 (85%) and 17 (15%) respectively of the HEs. The mean age (SD) of the subjects was 53.9 (14.4) years and their ages ranged from 22 to 86 years. DKA occurred in all subjects with type 1 DM and 73 (81%) of subjects with type 2 DM. The presence of HSS was noted in 17 (19%) of the subjects with type 2 DM.</p> <p>Hypokalaemia (HK) was documented in 41 (37%) of the study subjects. Elevated urea levels and hyponatraemia were noted more in subjects with DKA than in those subjects with HHS (57.5%,19% vs 53%,18%). The mortality rate for HEs in this report is 20% and the case fatality rates for DKA and HHS are 18% and 35% respectively.</p> <p>The predictive factors for HEs mortality include, sepsis, foot ulceration, previously undetected DM, hypokalaemia and being elderly.</p> <p>Conclusion</p> <p>HHS carry a higher case fatality rate than DKA and the predictive factors for hyperglycaemic emergencies' mortality in the Nigerian with DM include foot ulcers, hypokalaemia and being elderly.</p

ZRANB3 is an African-specific type 2 diabetes locus associated with beta-cell mass and insulin response.

Genome analysis of diverse human populations has contributed to the identification of novel genomic loci for diseases of major clinical and public health impact. Here, we report a genome-wide analysis of type 2 diabetes (T2D) in sub-Saharan Africans, an understudied ancestral group. We analyze ~18 million autosomal SNPs in 5,231 individuals from Nigeria, Ghana and Kenya. We identify a previously-unreported genome-wide significant locus: ZRANB3 (Zinc Finger RANBP2-Type Containing 3, lead SNP p = 2.831 × 10-9). Knockdown or genomic knockout of the zebrafish ortholog results in reduction in pancreatic β-cell number which we demonstrate to be due to increased apoptosis in islets. siRNA transfection of murine Zranb3 in MIN6 β-cells results in impaired insulin secretion in response to high glucose, implicating Zranb3 in β-cell functional response to high glucose conditions. We also show transferability in our study of 32 established T2D loci. Our findings advance understanding of the genetics of T2D in non-European ancestry populations

ZRANB3 is an African-specific type 2 diabetes locus associated with beta-cell mass and insulin response

Abstract: Genome analysis of diverse human populations has contributed to the identification of novel genomic loci for diseases of major clinical and public health impact. Here, we report a genome-wide analysis of type 2 diabetes (T2D) in sub-Saharan Africans, an understudied ancestral group. We analyze ~18 million autosomal SNPs in 5,231 individuals from Nigeria, Ghana and Kenya. We identify a previously-unreported genome-wide significant locus: ZRANB3 (Zinc Finger RANBP2-Type Containing 3, lead SNP p = 2.831 × 10−9). Knockdown or genomic knockout of the zebrafish ortholog results in reduction in pancreatic β-cell number which we demonstrate to be due to increased apoptosis in islets. siRNA transfection of murine Zranb3 in MIN6 β-cells results in impaired insulin secretion in response to high glucose, implicating Zranb3 in β-cell functional response to high glucose conditions. We also show transferability in our study of 32 established T2D loci. Our findings advance understanding of the genetics of T2D in non-European ancestry populations

Prevalence of a marker of active <it>helicobacter pylori</it> infection among patients with type 2 diabetes mellitus in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>There appears to exist a potentially important interplay between diabetes mellitus (DM) and <it>Helicobacter pylori (H. pylori)</it> infection. Findings from previous studies have been conflicting. Only a few studies have examined the topic in a sub-Saharan African population. This study sought to determine the prevalence of <it>H. pylori</it> infection among Type 2 diabetes mellitus (T2DM) patients in Lagos, Nigeria.</p> <p>Findings</p> <p><it>H. pylori</it> infection was detected in 18% of T2DM patients and 13% of controls but there was no statistical significance in this difference (p = 0.52). The prevalence of <it>H. pylori</it> was neither associated with the known duration of T2DM nor was it associated with age, gender, body mass index (BMI), smoking status. T2DM was not shown to be a risk factor independently associated with risk for <it>H. pylori</it> infection (OR = 0.87, 95% CI = 0.58-1.31, p = 0.57).</p> <p>Conclusions</p> <p>The lack of a statistical significant difference between the <it>H. pylori</it> infection rates in T2DM patients and controls suggests that the infection is not increased in T2DM. Larger studies need to be conducted to confirm the study findings.</p