Oral Glucose Tolerance Test among Adolescents with Impaired Fasting Blood Glucose

Background: Type 2 Diabetes Mellitus (DM) is emerging as a major health problem even amongst children and adolescents. The onset is usually preceded by period of impaired glucose metabolism known as Impaired Fasting Glucose (IFG) and or Impaired Glucose Tolerance (IGT). This study is aimed at determining the presence of impaired glucose tolerance in adolescents aged 10 to 19 years with impaired fasting glucose.Methodology: Oral glucose tolerance test was done for a cohort of 68 adolescents aged 10 to 19 years with impaired fasting blood glucose detected at a school screening. Age, sex, anthropometric measures (height, weight, BMI and BMI percentiles were determined using appropriate methods. Blood pressure and family history of DM was determined. IGT was determined as a two hour post glucose load blood glucose value of> 7.8mmol/l and< 11.1mmol/l.Result: The mean age of the subjects was 15.08 ± 2.03 years. There were 23 (33.8%) males and 45 (66.2%) females, giving a male to female ratio of 1:2. Thirteen (19.1%) were overweight/obese, 16 (23.5%) had family history of diabetes mellitus and 17(25%) had hypertension. Seven (10.3%) of the subjects had impaired glucose tolerance and no case of diabetes. The mean BMI and fasting blood glucose value was higher in subjects with impaired glucose tolerance compared to those without. There was no statistically significant difference in prevalence of hypertension, overweight/obesity and hypertension in group with or without impaired glucose tolerance.Conclusion: There was no concordance in occurrence of IFG and IGT. Mean fasting blood glucose and mean BMI was higher in those with both IFG and IGT. Screening for only IGT will therefore miss subjects with IFG.Keywords: Oral Glucose Tolerance Test; Impaired Fasting Blood Glucose; Adolescents; Nigeri

Growth hormone deficiency in a Nigerian child with Turner’s syndrome: a case report and review of growth assessment in children

Turner syndrome is the most common chromosomal abnormality affecting women with a prevalence of 1 in 2000 live births. Genetics show that most of the patients have monosomy 45 XO and the commonest phenotype is short stature. Growth hormone deficiency is uncommon but consensus statements have endorsed GH treatment for short girls with Turner syndrome.Case report: A 15 year old Turner syndrome patient who had delayed evaluation for short stature was noticed to be short for age, with a height of 125 cm (-5SDS). Growth hormone stimulation test revealed growth hormone deficiency and she was commenced on growth hormone therapy.Conclusion: Simple and regular measurement of children’s height with chart plotting is necessary to pick up children who have short stature. Growth hormone treatment early in the course of management of a child with Turner syndrome may help achieve normal final height.Keywords: Turner’s syndrome, short stature, growth hormone deficiency, growth hormone treatment, Nigeri

Survey on knowledge of healthcare providers about childhood Diabetes Mellitus in tertiary healthcare institution in a resource-limited setting

Background: With increasing prevalence of childhood DM, it is important that health care providers know about the disease and manage this properly. We aimed to survey the knowledge and experience of health care providers in tertiary institution so as to make informed recommendations.Methods: Pretested self-administered and standardised questionnaires were distributed to nurses, and residents including paediatricians- in - training in a tertiary health institution. The knowledge and proficiency questionnaires were made simple and multi choice to reduce ambiguity. Mean knowledge was compared using ANOVA, and Tukey post hoc analyses and p values <0.05 were considered significant.Results: Two hundred questionnaires were distributed and 185 were returned filled giving a response rate of 92.5%. There were 80 (43.2%) nurses, and 105 (56.8%) doctors, 41 (22.2%) of which were paediatricians or paediatricians-in-training. Paediatric residents had higher overall mean knowledge in all aspects evaluated. About 60% of respondents correctly identified diagnosis of DM based on FBG, and 61.6% got the response for random BG. Forty six (24.9%) of respondents did RBG for all children attending their facilities, only 16 of these were paediatric residents. Nurses were willing to give OHA to established T1DM children.Conclusion: Many health workers have little knowledge and practice experience in DM with the attendant effect of poor management of these children. We thus recommend a review of undergraduate medical curriculum, and CME to limit this dearth in knowledge.Keywords: Survey, Knowledge, Diabetes Mellitus, Health care providers, Nigeri

Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria

<p>Abstract</p> <p>Background</p> <p>Infants born to diabetic women have certain distinctive characteristics, including large size and high morbidity risks. The neonatal mortality rate is over five times that of infants of non diabetic mothers and is higher at all gestational ages and birth weight for gestational age (GA) categories.</p> <p>The study aimed to determine morbidity and mortality pattern amongst infants of diabetic mothers (IDMS) admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital.</p> <p>Methods</p> <p>This was a study of prevalence of morbidity and mortality among IDMs carried out prospectively over a two year period. All IDMs (pregestational and gestational) admitted into the Unit within the period were recruited into the study.</p> <p>Data on delivery mode, GA, birth weight, other associated morbidities, investigation results, treatment, duration of hospital stay and outcome were collated and compared with those of infants of non diabetic mothers matched for GA and birth weight admitted within the same period. Maternal data were reviewed retrospectively. Data were analyzed using SPSS 16.0.</p> <p>Results</p> <p>Sixty percent of the IDMs were born to mothers with gestational diabetes, while 40% were born to mothers with pregestational DM. 38 (74.3%) were born by Caesarian section (CS), of which 20 (52.6%) were by emergency CS. There was no significant difference in emergency CS rates, when compared with controls, but non-IDMs were more likely to be delivered vaginally. The mean GA of IDMs was 37.84 weeks ± 1.88. 29 (61.7%) of them were macrosomic. The commonest morbidities were Hypoglycemia (significantly higher in IDMs than non-IDMs) and hyperbilirubinaemia in 30 (63.8%) and 26 (57.4%) respectively.</p> <p>There was no difference in morbidity pattern between infants of pre- gestational and gestational diabetic mothers. Mortality rate was not significantly higher in IDMs</p> <p>Conclusions</p> <p>The incidence of macrosomia in IDMs was high but high rates of emergency CS was not peculiar to them. Hypoglycaemia and hyperbilirubinaemia were the commonest morbidities in IDMs.</p> <p>Referring women with unstable metabolic control to specialized centers improves pre- and post- natal outcomes. Maternal-Infant centers for management of diabetes in pregnancy are advocated on a national scale to reduce associated morbidity and mortality</p

Frequency and Predisposing Factors to Hypoglycaemic Events: Experiences at a Diabetes Youth Camp in Sub-Saharan Africa

Background: Early detection and management of hypoglycaemia is an integral part of care in diabetes camps. The objective of this report was to present the frequency of hypoglycaemic events and possible predisposing factors in a diabetes camp in Nigeria.Methodology: The blood glucose recordings for twenty one children and adolescent aged 6 years to 19 years who attended aweekend diabetescamp were analyzed. Further information about subjects was retrieved from completed pre camp documents.Results: Eight (38.1%) campers had hypoglycaemia and 7(43.8%) of the episodes occurred at 2am check. Hypoglycaemia was recorded in 17(7%) of 252 blood glucose recorded with a rate of 0.4 per camper/day. The mean insulin unit/kg/day was significantly higher in children with hypoglycaemia compared with those without (p= 0.03). 40% of campers with HBA1C less than 7.5 had hypoglycaemia and the mean HBA1C and BMI Z score of campers with hypoglycaemia was lower than in those without. This finding was however not statistically significant. Fifty percent of younger campers aged 6 to 12years had hypoglycaemia compared to 35% of older campers.There was no statistically significant relationship between age, sex, duration of diabetes and occurrence of hypoglycaemia.Conclusion: More than a quarter of campers had hypoglycaemia. Mean insulin dose was significantly higher in campers who experienced hypoglycaemi compared to those who did not. Frequency of hypoglycaemia was higher at 2 am check and following hiking before lunch

Microalbuminuria in type 1 diabetes mellitus children in University of Port Harcourt Teaching Hospital, Nigeria

Introduction:&nbsp;glycaemic control is usually best achieved using the basal bolus regimen, however, this is not always available in resource-limited settings. Long-term complications like renal parenchymal disease are consequences of poor glycaemic control. Screening type 1 diabetes patients irrespective of their disease duration was used to buttress the need for ethical principles of justice to be incorporated in the care of type 1 diabetes children. Methods:&nbsp;urine albumin creatinine ratio (UAC) was calculated for 20 type 1 diabetes mellitus children in the endocrinology clinic after submitting early morning urine over a 4-month period. The calculated ratio was compared between duration of disease (&lt; 5 years and &gt; 5 years) and between insulin regimen types (mixtard and basal bolus). Repeat tests were done for children who had elevated UAC ratio levels after 2 months. Results:&nbsp;there were 5 males and 15 females and the mean UAC ratio of the cohort was 123mg/g with a range of 5.30 − 906 mg/g. Twelve children (8 diagnosed less than 5 years) had UAC ratio ≥ 30mg/g with a mean of 193.15. The repeat mean UAC ratio for these was 144.35 mg/g. Children who had diabetes for more than 5 years and were on mixtard had higher UAC ratio than those with diabetes &lt; 5 years and on basal bolus. Conclusion:&nbsp;the prevalence of microalbuminuria is high in our cohort of type 1 diabetes children and these were children on mixtard and had diabetes greater than 5 years

Newborn screening in Nigeria: Associating the screening of congenital hypothyroidism and sickle cell disease can be a winning choice?

ntroduction: Nigeria like many African countries has tried to start the newborn screening for congenital hypothyroidism and many failed. Since sickle cell disease is more common in Nigeria, the hypothesis is that incorporating it into a screening programme for congenital hypothyroidism will improve the uptake of the programme by parents and government