State of Diabetes Care in Nigeria: A Review

Background: The prevalence of diabetes mellitus is rising in Nigeria and its complications present an immense public health burden.Objective(s): The objective of this discourse is to review the state of diabetes care in Nigeria with focus on the needs, priorities and recommendations, which should guide our clinicians. It will discuss the definition, pattern, landmark Nigerian studies on diabetes care, matters arising, morbidity/mortality and proposed strategies for improving diabetes care in Nigeria.Methods (Data Sources /extraction): The data search used in this review covered studies published from 1959-2010, obtained from prevalence studies, hospital statistics, registry reports, landmark hospital-basedstudies, recent international conference proceedings, world health reports, government estimates, United Nations resolutions on diabetes, international diabetes federation (IDF) declarations and clinical practice guidelines. The medline database, the internet (e-medicine, medscape resource etc), journal articles, World Health and  international diabetes federation (IDF) monographs were used.Results: The rising prevalence of diabetes as well as its associated morbidity / mortality, preventive measures and effective treatments are well recognized. However, in practice this knowledge is under- utilized because only about a third of Nigerians living with diabetes achieve optimum targets (glycaemic control, blood pressure, lipids and weight).Conclusion: Most Nigerians living with diabetes have suboptimal control, are hypertensives and have chronic complications. Improved quality of care and treatmentto- target is recommended to reduce diabetes-related morbidity and mortality.Keywords: State, diabetes care, recommendations, NCDs, United Nations

Insulin Injection Practices In People with Diabetes Mellitus

Background: The significance of achieving good glycaemic control cannot be over-emphasized as this goes a long way in the reduction of disease burden arising from diabetes mellitus. In Nigeria, insulin injections are still widely unacceptable thus posing a problem towards achieving optimal glycaemic control in insulin requiring diabetes patients. Aim: This study aimed to provide information on insulin usage in Nigeria. Patients and Methods: The study was carried out in the Lagos State University Teaching Hospital (LASUTH) and the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Participants were recruited from patients receiving care at the Diabetes Clinic of the above mentioned hospitals. It is a descriptive study in which 100 insulin-requiring diabetes patients were studied via the use of intervieweradministered questionnaire. Results: Essentially, insulin techniques, glycaemic control and complications of insulin usage were documented. Conclusions: The main form of insulin used is the human insulin. High cost of insulin is one of the major factors responsible for poor glycaemic control. For proper delivery of diabetes care, insulin, insulin pens and syringes must be available, accessible and at affordable cost. Keywords: Diabetes mellitus, Insulin injections, Glycaemic contro

Diabetes and related diseases in Nigeria: Need for improved primary care in rural communities

Background: The political commitments necessary to tackle the growing burden of diabetes mellitus (DM) and related NCDs have increased in recent years in Nigeria. This has resulted in the development of national policy and strategic objectives by the Federal Ministry of Health for the prevention and control of NCDs in Nigeria. This paper aims at highlighting a framework for integrating Diabetes and other related NCDs into primary health care.Materials and Methods: Data identification methods included internet search (using search engines and online databases) and in the libraries. Sources of information include international, regional, national and local healthcare policies and regulations. Peer-reviewed academic and research papers were identified.Results and Discussion: Prevention and care are both essential components in the control of diseases such as DM and hypertension, and a large evidence base is available on cost-effective interventions for prevention and control. However, ways of implementing these interventions and incorporating them into policies and practice in Nigeria remains a challenge. The delivery of care in such scenario will require the development of case management model(s), containing a core set of evidence-based diagnostics, essential medicines, behaviour change interventions and supporting tools for service performance monitoring.Conclusion: DM, including related NCDs are increasing in prevalence in Nigeria, and their complications pose an immense public health burden. There is a need for our health decision-makers at all levels to develop strategies and interventions to halt the growing trend and burden of diabetes through effective primary care, especially in rural communities of Nigeria.Keywords: Diabetes, Non-Communicable Diseases (NCDs), Primary Care, Rura

Selfmonitoring of blood glucose practices by people living with diabetes who use their personal glucometers in Port Harcourt, Niger Delta Region, Nigeria

Self-monitoring of blood glucose (SMBG) assists persons living with diabetes with the day-to-day behavioral and therapeutic adjustments to their diabetes care. It is a cheaper and more available alternative to glycated haemoglobin (HbA1c) in Nigeria for monitoring glycaemic control. Information on SMBG practices of Nigerians living with diabetes using their personal glucometers is scanty. The aim of the study is to assess the intensity and frequency of SMBG by glucometer owners, and the extent the patients and/or the health care providers (HCP) utilize SMBG to achieve personalized treatment goals via behavioral/treatment adjustments. This was a cross sectional study carried out among persons living with diabetes that accessed diabetes care at the diabetes clinic of the University of Port Harcourt Teaching Hospital (UPTH) and using their personal glucometers. They were consecutively recruited. Data obtained by using intervieweradministered questionnaires were analyzed using SPSS version 20.0, and pvalue <0.05 was considered significant. A total of 128 persons living with diabetes participated in the study of which 40 (31%) were males and 88 (69%) were females; the mean age of the subjects was 52.05 ± 11.24 years with a range of 26–70 years. The majority of the study subjects (72%) were in the active working age group (25–60years). The highest frequency of glucometer use was in the 26 subjects (20%) who checked their blood glucose every morning while 62 (48%) of the subjects checked their blood glucose any morning they felt like. Most of the subjects (60%) did not have any recording device. Glucometer owners were not just the insulin-requiring people living with diabetes as more than half of the subjects, 66 (52%) were on oral anti diabetic drugs (OAD) only. Glucometer ownership was mainly by those that were in the working age group. SMBG protocol (frequency) was variable and SMBG data were not maximally utilized.Keywords: Self-monitoring of blood glucose; Personal glucometer; Diabetes; Blood glucos

Connecting peptide (c-peptide) and the duration of diabetes mellitus amongst patients, at the Federal Medical Centre (FMC), Owerri, southeast, Nigeria

Objective: C-peptide is derived from proinsulin and it is secreted in equimolar concentration with insulin. Plasma C-peptide is more stable than insulin and it provides an indirect measure of insulin secretory reserve and beta cell function. To determine relationship between C-peptide and duration of diabetes mellitus, age, body mass index, systolic blood pressure and diastolic blood pressure.Methods: This is a cross-sectional study of type 2 diabetes mellitus patients attending Endocrine Clinic. Information such as age, sex, height, weight, blood pressure and duration of diabetes were obtained. Blood samples were taken for fasting serum C-peptide. Data was analysed using SPSS version 16.Results: Out of the 46 subjects recruited 23 (50%) were females and 23 (50%) were males. The mean age was 55.63 ± 14.7 years. Mean duration of diabetes for both sexes was 8 years with a range of 1 to 32 years. The mean BMI was 26.87 ± 5.00 kg/m2for males and 30.09 ± 4.32 Kg/m2 for females. The mean fasting serum C-peptide was 2.16 ± 1.41 ng/ml and there was no significant difference between males and females. There is statistically significant inverse correlation between C-peptide and duration of diabetes (r= -0.356, p= 0.015). Conversely there is a direct relationship between C-peptide and BMI (r=0.307, p=0.038).Conclusion: Increasing duration of diabetes is associated with decreasing level of C-peptide and decreased beta cell secretory reserv

Clinical and Practice Variations in Pediatric Acute Recurrent or Chronic Pancreatitis: Report From the INSPPIRE Study

Objective: The aim of the study was to determine whether clinical characteristics and management of pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) differ across INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a cuRE) sites. Study design: Data were collected from INSPPIRE and analyzed per US regions and "non-US" sites. Between-group differences were compared by Pearson chi-square test. Differences in disease burden were compared by Kruskal-Wallis test. Results: Out of the 479 subjects, 121 (25%) were enrolled in West, 151 (32%) Midwest, 45 Northeast (9%), 78 (16%) South, and 84 (18%) at non-US sites. Hispanic ethnicity was more common in South (P < 0.0001); white race in Northeast (P = 0.009). CP was less common and time from diagnosis of first acute pancreatitis to CP was longer in children at non-US sites (P = 0.0002 and P = 0.011, respectively). Genetic mutations were most common among all groups; PRSS1 variants predominated in Midwest (P = 0.002). Gallstones were more frequent in South (P = 0.002). Endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) imaging were more commonly utilized in United States compared with non-United States (P < 0.0001), but there were no differences in the use of MRI/MRCP. Disease burden was highest in the West and Midwest, possibly as total pancreatectomy and islet autotransplantation (TPIAT) referral sites were located in these regions. All therapies were less commonly administered in non-US sites (P < 0.0001). Conclusions: This is the first study to describe geographical variations in the INSPPIRE cohort, which possibly reflect variations in practice and referral patterns. The underlying reason behind the lower frequency of CP and fewer treatments in non-United States sites need to be further explored