Should we assume accuracy of point of care glucose meters? An observation from a tertiary health care centre

Background: Self-monitoring of blood glucose is important in the management of patients with diabetes mellitus in the community as well as in the hospital. It has been used for calculation of insulin doses of individuals with dysglycaemia and monitoring of glucose control. Errors in the measurement of the blood glucose can lead poor management of a patient. There is therefore the need to ensure standardization of these meters in order to achieve accuracy and precision.Objectives: To evaluate the precision and accuracy of four glucose meters commonly used for self-monitoring of blood glucose (SMBG) in a tertiary health care Centre compared to the reference laboratory method.Materials and Methods: We analyzed blood glucose samples of 55 diabetic patients who came to diabetes clinic using 4 different glucose meters (Accucheck active, Novo max extra, One touch Ultra 2 and On call plus (accoson)). Capillary and Venous blood samples were taken simultaneously from each patient for analysis using four blood glucose meters and laboratory reference method respectively. The laboratory value was used as a tool for comparison. The accuracy and precision were evaluated by the ISO and ADA criteria. The results obtained were analysed using Bland Altman graphs, correlation coefficients, scatter plots and Clarke's error grid analysis.Results: We observed good correlation between two glucose meters (AccucheckTM and NovomaxTM) and laboratory analyzed values. Among the glucose meters AccucheckTM, NovomaxTM, One touch UltraTM and On call plusTM, the correlation coefficient was 0.97, 0.96, 0.88 and 0.69 respectively. The degree of agreement of the laboratory method and the AccucheckTM, NovomaxTM, One touch ultraTM and On call plusTM glucose meters was 89.09, 80.00, 76.20 and 71.32% respectively. Accucheck and NovomaxTM were within ±20% accuracy (14.5% and 16.1%).Conclusion: There is a need for adequate and appropriate evaluation of all glucose meters in our setting before that we deploy them for use. None of glucose meters met the ISO target. Only one glucose meter (AccucheckTM) met the ADA guideline for accuracy.Keywords: Accuracy; glucose meters; diabetes mellitus; self-monitoring of blood glucos

Prevalence and determinants of glucose intolerance among HIV/AIDS patients in north-central Nigeria

Background: The advent of potent antiviral drugs has revolutionalised the clinical course of HIV / AIDS resulting in increased survival and improved quality of life. Metabolic derangements in HIV infected patients are becoming more common probably due to this increased survival from the use of HAART. There is limited data on the occurrence of glucose intolerance among HIV patients in Nigeria.Objective: To determine the prevalence of glucose intolerance and associated risk factors in HIV/AIDS patients.Methods: Consenting adult HIV patients at the HIV clinic of the Jos University Teaching Hospital (JUTH), Jos , Nigeria were evaluated were evaluated for the presence of glucose intolerance using a 75g oral glucose tolerance test (OGTT). There clinical characteristics, anthropometry, CD4 cell counts and viral load were determined using appropriate standard techniques. Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), and Diabetes Mellitus (DM) were defined based on the American Diabetes Association (ADA) cut-off values.Results: Of the 584 patients studied, 384 (130 males and 251 females) with mean±SD age of 38±15 years were HAARTtreated; while 200 (61 males and 139 females) with mean±SD age of 33±17 years were HAART-naive. Overall, the prevalence of GI was 40.4% (IFG) 19.5%, IGT 11.5% and DM 9.4%. The prevalence of IFG (27.1%) and DM (11.2%) in HAART - treated patients were observed and those in HAART-naive patients were (IFG 5.0%,DM 6.0%), p<0.005. IGT was more prevalent in HAART-naive than in HAART-treated patients (19.5%, and 7.3% respectively), p<0.05. The proportions of patients with GI were higher in overweight and obese HAART-treated patients with moderate CD4 cell count (200-500 x106 cell/L); while in the HAART-naive patients, GI was more prevalent in underweight subjects with CD4 cell count (<200 x 106 cell/L). The Determinants of GI were age, increasing BMI, low CD4 cell count, metabolic syndrome and HAART treatment duration. The independent predictors of glucose intolerance in HIV / AIDS patients were low CD4 cell count and prolonged HAART treatment duration.Conclusion: The prevalence of GI among HIV/AIDS patients in North-Central Nigeria is high. Treatment with HAART and low CD4 cell count are strong determinants of glucose intolerance in our HIV / AIDS patients. Regular screening for glucose intolerance among our HIV / AIDS patients is recommended.Keywords: HIV, Glucose Intolerance, Prevalence, North-Central Nigeri

Choice of antihypertensive medications among physicians and its impact on blood pressure control among Nigerians living with hypertension

Background: Hypertension, if untreated or uncontrolled, leads to damage of vital organs such as the brain, heart and the kidneys among others. These complications have been shown to be severer in black Africans. Benefit of treatment has been repeatedly demonstrated by many studies. Therefore, many guidelines have been produced by relevant bodies in different countries in order to assist physicians in making the right choices for blood pressure (BP) control. Most of these bodies produce the guidelines based on the peculiarities of hypertension in their respective population. Several reports have shown how different hypertension is, in black Africans, still there is no published unified guideline for its treatment in this population.Methods: This was a survey of known hypertensives who were on follow up visit. Their prescriptions were assessed for drug name, class and number. Their blood pressures at that visit were also recorded. Prevalence of single therapy and combination therapy were determined. Compliance with the AHA recommended 2 – drug combination was determined. The percentage of BP control as well as the prescribed drugs in each group were also obtained.Results: Those on single agents were 13% out of which 52% were controlled. 87% were on various combination of 2 or more drugs of whom 41.9% of those on 2 drugs and 21.1% of those on more than 2 drugs had controlled BP. BP control in those on 2 drugs was better than in those with > 2 drugs, (p=0.0027).ACEI were the commonest used drug either as single agent (55.9%) or as 2 – drug combination as seen in 54.8% of the subjects on 2 – drug combination. 13 different 2 – drug combinations were identified with the best control in ARB + Diuretic, ACEI + Diuretic and CCB + Diuretic. The least control was observed in the ACEI + CCB group. Compliance with AHA recommendation was good but still 7.7% were under unacceptable group while another 7.7% were unclassified.Conclusion: ACE-Is are becoming the drugs of choice both as monotherapy and as combination therapy. Despite good compliance to AHA recommendation on drug combination, overall control is still a problem which calls for a revisit of these recommendations in Africans.Keywords: Ahtihypertensives; Physicians; Impact; Blood Pressure; Nigerian

Profile of Nigerians with diabetes mellitus - Diabcare Nigeria study group (2008): Results of a multicenter study

Background: Diabetes Mellitus is the commonest endocrine-metabolic disorder in Nigeria similar to the experience in other parts of the world. The aim was to assess the clinical and laboratory profile, and evaluate the quality of care of Nigerian diabetics with a view to planning improved diabetes care. Materials and Methods: In a multicenter study across seven tertiary health centers in Nigeria, the clinical and laboratory parameters of diabetic out-patients were evaluated. Clinical parameters studied include type of diabetes, anthropometry, and blood pressure (BP) status, chronic complications of diabetes, and treatment types. Laboratory data assessed included fasting plasma glucose (FPG), 2-h post-prandial (2-HrPP) glucose, glycated hemoglobin (HbA1c), urinalysis, serum lipids, electrolytes, urea, and creatinine. Results: A total of 531 patients, 209 (39.4%) males and 322 (60.6%) females enrolled. The mean age of the patients was 57.1 ± 12.3 years with the mean duration of diabetes of 8.8 ± 6.6 years. Majority (95.4%) had type 2 diabetes mellitus (DM) compared to type 1 DM (4.6%), with P < 0.001. The mean FPG, 2-HrPP glucose, and HbA1c were 8.1 ± 3.9 mmol/L, 10.6 ± 4.6 mmol/L, and 8.3 ± 2.2%, respectively. Only 170 (32.4%) and 100 (20.4%) patients achieved the ADA and IDF glycemic targets, respectively. Most patients (72.8%) did not practice self-monitoring of blood glucose. Hypertension was found in 322 (60.9%), with mean systolic BP 142.0 ± 23.7 mmHg, and mean diastolic BP 80.7 ± 12.7 mmHg. Diabetic complications found were peripheral neuropathy (59.2%), retinopathy (35.5%), cataracts (25.2%), cerebrovascular disease (4.7%), diabetic foot ulcers (16.0%), and nephropathy (3.2%). Conclusion: Most Nigerian diabetics have suboptimal glycemic control, are hypertensives, and have chronic complications of DM. Improved quality of care and treatment to target is recommended to reduce diabetes-related morbidity and mortality

Prevalence and Risk Factors for Diabetes Mellitus in Nigeria: A Systematic Review and Meta-Analysis

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